Healthcare Provider Details

I. General information

NPI: 1942802202
Provider Name (Legal Business Name): JORDAN YUHAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 W COLONIAL DR
OCOEE FL
34761-2946
US

IV. Provider business mailing address

4997 WILDWOOD POINTE RD
WINTER GARDEN FL
34787-5376
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-6910
  • Fax:
Mailing address:
  • Phone: 315-771-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: