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NPI Code Detail

MEDICARE: JORDAN M. CRESSWELL PHARM.D.

MEDICARE: JORDAN M. CRESSWELL PHARM.D.
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
1183500000XPharmacist2012033704MO

General Provider Information

NPI Number : 1932443785
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN M. CRESSWELL PHARM.D.
Provider Business Mailing Address
First Line : 9801 MANCHESTER RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63119-1227
Country : US
Telephone Number : 314-963-3256
Fax Number : 314-963-0184
Provider Business Practice Location Address
First Line : 9801 MANCHESTER RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63119-1227
Country : US
Telephone Number : 314-963-3256
Fax Number : 314-963-0184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2012
Last Update Date : 11/18/2012

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