Provider Demographics
NPI:1801880562
Name:GORDON, BRUCE MYRON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MYRON
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 1:310 OTTO LN
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1056
Mailing Address - Country:US
Mailing Address - Phone:410-674-5181
Mailing Address - Fax:
Practice Address - Street 1:310 OTTO LN
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1056
Practice Address - Country:US
Practice Address - Phone:410-674-5181
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9123183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy