MEDICARE: JORDAN OLIVIA FYOCK 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
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RP456943	PA

General Provider Information

NPI Number	:	1942982343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN OLIVIA FYOCK PHARMD

Provider Business Mailing Address
First Line	:	1398 OLD FORBES RD
Second Line	:
City	:	STOYSTOWN
State	:	PA
Zip	:	15563-8765
Country	:	US
Telephone Number	:	814-659-3676
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 GALLERIA DR
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-8900
Country	:	US
Telephone Number	:	814-943-8164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	07/03/2025

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