Provider Demographics
NPI:1427527837
Name:GORDON, STEVEN KEITH (RPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:KEITH
Last Name:GORDON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 US HIGHWAY 80 STE B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:GA
Mailing Address - Zip Code:31302-4557
Mailing Address - Country:US
Mailing Address - Phone:912-988-1780
Mailing Address - Fax:
Practice Address - Street 1:3010 US HIGHWAY 80 STE B
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:GA
Practice Address - Zip Code:31302-4557
Practice Address - Country:US
Practice Address - Phone:912-988-1780
Practice Address - Fax:912-988-1784
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist