MR. MARK GORDON (NPI# 1841576543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841576543 |
| Entity Type | Individual |
| Full Name | MR. MARK GORDON |
| Credential | PHARMD |
| Practice Address |
1305 N Casaloma Dr Grand Chute WI 54913-8848 |
| Practice Telephone | 9207308218 |
| Practice Fax Number | 9207308287 |
| Mailing Telephone | 9207308218 |
| Mailing Fax Number | 9207308287 |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 15530-040 | WI | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497183404 | Mark Gordon | Homemaker | 16938 S Dixie Hwy, Palmetto Bay, FL 33157-4354 | 2013-10-30 |
| 1750409629 | Mark A Gordon | Physician Assistant | 13601 Wood Forest Blvd, Houston, TX 77015 | 2007-03-27 |
| 1356365126 | Mark Richard Gordon | Dentist | 2121 Eisenhower Ave, Suite 502, Alexandria, VA 22314-4698 | 2006-07-26 |
| 1568420099 | Mark Jay Gordon | Optometrist | 978 Colvin Blvd, Kenmore, NY 14217-2128 | 2006-05-03 |
| 1396734331 | Mark Howard Gordon | Dentist | 15 Fletcher Ave, Valley Stream, NY 11580-4000 | 2005-10-20 |
| 1386643740 | Mark J Gordon | Dentist | 4121 W 83rd St, Suite 212, Prairie Village, KS 66208-5300 | 2005-07-19 |
| 1528489184 | Mark Gordon | Nurse Anesthetist, Certified Registered | 1 Saint Joseph Dr, Lexington, KY 40504-3742 | 2013-12-30 |
| 1306987946 | Mark Lorry Gordon | Family Medicine | 16661 Ventura Blvd, Suite 716, Encino, CA 91436-1914 | 2007-02-08 |
| 1891869202 | Mark Gordon | Optometrist | 230 W Jersey St, Suite 201, Elizabeth, NJ 07202-1364 | 2006-11-17 |
| 1821028382 | Mark B Gordon | Optometrist | 100 Park Ave, Baltimore, MD 21201-3416 | 2006-07-03 |
| Street Address |
1305 N CASALOMA DR |
| City | GRAND CHUTE |
| State | WI |
| Zip Code | 54913-8848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043225121 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1305 N Casaloma Dr, Grand Chute, WI 54913-8848 | 2006-07-29 |
| 1629354691 | Trisha Doell | Pharmacist | 1305 N Casaloma Dr, Grand Chute, WI 54913-8848 | 2011-10-22 |
| 1477833127 | Laura Jasperson | Pharmacist | 1305 N Casaloma Dr, Grand Chute, WI 54913-8848 | 2011-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994584 | Pamela J Andersen | Music Therapist | 245 N. Metro Drive, Appleton, WI 54913 | 2019-10-22 |
| 1396387510 | Nancy Sibley | Technician | N4423 County Road Ee, Appleton, WI 54913 | 2019-10-09 |
| 1659872240 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 3801 N. Richmond Street, Grand Chute, WI 54913 | 2018-02-28 |
| 1780116244 | Alison Pelger | Physician Assistant | 3916 North Intertech Court, Appleton, WI 54913 | 2017-04-03 |
| 1316311905 | Lucy Bouressa | Specialist/Technologist | 2105 E. Enterprise Ave, 113, Appleton, WI 54913 | 2015-11-19 |
| 1992189989 | Brittany Reinke | Physical Therapist | Walking and Wheeling, LLC, W4652 Glenn Street, Appleton, WI 54913 | 2015-07-20 |
| 1902280092 | Costco Wholesale Corporation | Pharmacy | 5401 W Integrity Way, Grand Chute, WI 54913 | 2015-07-17 |
| 1942646849 | Richard Anthony Mauthe | Pharmacist | 5401 W. Integrity Way, Neenah, WI 54913 | 2013-05-17 |
| 1750622163 | Tonya Janelle Wilderman | Pharmacist | 1400 N Mccarthy Rd, Apt 2, Grand Chute, WI 54913 | 2013-03-10 |
| 1295938777 | Jenna Marie Kadlec | Physical Therapist | 3916 N. Intertech Court, Appleton, WI 54913 | 2007-06-11 |
| Find all providers in zip 54913 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750622163 | Tonya Janelle Wilderman | Pharmacist | 1400 N Mccarthy Rd, Apt 2, Grand Chute, WI 54913 | 2013-03-10 |
| 1215286752 | Jose M Carrasco | Pharmacist | 4016 Towne Lakes Cir, Apt #7212, Grand Chute, WI 54913-8006 | 2012-08-30 |
| 1760872287 | James Dreier | Pharmacist | 2400 W Wisconsin Ave, Grand Chute, WI 54914-3109 | 2015-02-04 |
| 1629354691 | Trisha Doell | Pharmacist | 1305 N Casaloma Dr, Grand Chute, WI 54913-8848 | 2011-10-22 |
| 1477833127 | Laura Jasperson | Pharmacist | 1305 N Casaloma Dr, Grand Chute, WI 54913-8848 | 2011-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164349 | Lynn Huynh | Pharmacist | 5695 Washington Ave, Racine, WI 53406 | 2020-11-06 |
| 1346841822 | Tam Dinh | Pharmacist | 7480 Karth Ct, Franklin, WI 53132-8509 | 2020-11-02 |
| 1356940845 | Colette A. Probasco | Pharmacist | N1021 Blues Ln, Hortonville, WI 54944-9265 | 2020-10-26 |
| 1104425784 | Seang Foo | Pharmacist | 875 E Wisconsin Ave # Ms 2870, Milwaukee, WI 53202-5404 | 2020-10-23 |
| 1053910067 | Mary Ellen F Pumper | Pharmacist | 861 County Rd F, Berlin, WI 54923 | 2020-10-21 |
| 1609475607 | Suchart Thammahong | Pharmacist | 734 Mclean Drive, Madison, Wi, WI 53718 | 2020-10-21 |
| 1427657493 | Sarah R. Kozikowski | Pharmacist | 226100 Rib Mountain Dr, Wausau, WI 54401-3346 | 2020-10-21 |
| 1063011252 | Kelsey Eickstaedt | Pharmacist | 15594 State Hwy 77, Hayward, WI 54843 | 2020-10-20 |
| 1295334373 | James Michael Branning | Pharmacist | 226200 Rib Mountain Dr, Wausau, WI 54401-3347 | 2020-10-20 |
| 1174122576 | Paul Suiven Mbinglo | Pharmacist | 6237 94th Ct, Kenosha, WI 53142-8225 | 2020-10-19 |
| Find all providers with the same taxonomy | ||||
| City | GRAND CHUTE |
| Zip Code | 54913 |
Please comment or provide details below to improve the information on MR. MARK GORDON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.