Healthcare Provider Details

I. General information

NPI: 1285725911
Provider Name (Legal Business Name): CAROLYN M JORDAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

4113 HARFORD CREAMERY RD
WHITE HALL MD
21161-9310
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7106
  • Fax:
Mailing address:
  • Phone: 410-557-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number06827
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: