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NPI Code Detail

MEDICARE: JORDAN MARLEE LEGRETT PHARMD

MEDICARE: JORDAN MARLEE LEGRETT PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051.298837IL

General Provider Information

NPI Number : 1396111852
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MARLEE LEGRETT PHARMD
Provider Business Mailing Address
First Line : 375 THELMA ST
Second Line :
City : MANHATTAN
State : IL
Zip : 60442-9263
Country : US
Telephone Number : 815-861-5494
Fax Number :
Provider Business Practice Location Address
First Line : 21152 N LAGRANGE RD
Second Line :
City : FRANKFORT
State : IL
Zip : 60423-2010
Country : US
Telephone Number : 815-464-5050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2015
Last Update Date : 08/18/2015

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Directions to “ JORDAN MARLEE LEGRETT PHARMD” Practice Location

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