Provider Demographics
NPI:1174135750
Name:GORDON, HEATHER (PHARM D)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1931
Mailing Address - Country:US
Mailing Address - Phone:716-634-7901
Mailing Address - Fax:716-634-7907
Practice Address - Street 1:9217 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1931
Practice Address - Country:US
Practice Address - Phone:716-634-7901
Practice Address - Fax:716-634-7907
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018498183500000X
NY067790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist