Healthcare Provider Details

I. General information

NPI: 1306053798
Provider Name (Legal Business Name): JOHN T. JORDAN JR. PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

5653 KINGSMILL DR
SALISBURY MD
21801-7472
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7054
  • Fax: 410-543-7485
Mailing address:
  • Phone: 410-749-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number13905
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: