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NPI Code Detail

MEDICARE: JORDON HUTSON

MEDICARE: JORDON HUTSON
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
1183500000XPharmacist65148FL

General Provider Information

NPI Number : 1912604406
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDON HUTSON
Provider Business Mailing Address
First Line : 181 E NEW ENGLAND DR
Second Line :
City : ELKTON
State : FL
Zip : 32033-4051
Country : US
Telephone Number : 904-501-7539
Fax Number :
Provider Business Practice Location Address
First Line : 1590 DUNLAWTON AVE
Second Line :
City : PORT ORANGE
State : FL
Zip : 32127-4752
Country : US
Telephone Number : 386-461-0191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2023
Last Update Date : 02/14/2023

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