Provider Demographics
NPI:1053405092
Name:GORDON DRUG COMPANY INC.
Entity type:Organization
Organization Name:GORDON DRUG COMPANY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:865-691-8822
Mailing Address - Street 1:7255 OAK RIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2614
Mailing Address - Country:US
Mailing Address - Phone:865-691-8822
Mailing Address - Fax:865-691-7653
Practice Address - Street 1:7255 OAK RIDGE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-2614
Practice Address - Country:US
Practice Address - Phone:865-691-8822
Practice Address - Fax:865-691-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454330Medicaid
TN4658480001Medicare ID - Type Unspecified