Provider Demographics
NPI:1871340166
Name:GORDON, NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 HOSPITAL AVE
Mailing Address - Street 2:INPATIENT PHARMACY
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2584
Mailing Address - Country:US
Mailing Address - Phone:413-664-5272
Mailing Address - Fax:
Practice Address - Street 1:71 HOSPITAL AVE
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2584
Practice Address - Country:US
Practice Address - Phone:413-664-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist