Provider Demographics
NPI:1992342778
Name:GORDON, CAMERON (PHARMD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E 3500 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3530
Mailing Address - Country:US
Mailing Address - Phone:801-341-6515
Mailing Address - Fax:
Practice Address - Street 1:1550 E 3500 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3530
Practice Address - Country:US
Practice Address - Phone:801-341-6515
Practice Address - Fax:801-341-6516
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7820999-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist