Healthcare Provider Details

I. General information

NPI: 1306594585
Provider Name (Legal Business Name): JORDAN SIEMBOR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE
NEW HAVEN CT
06519-1300
US

IV. Provider business mailing address

30 OUTLOOK AVE APT 105
WEST HARTFORD CT
06119-1434
US

V. Phone/Fax

Practice location:
  • Phone: 888-461-0106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPCT.00149446
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: