Healthcare Provider Details

I. General information

NPI: 1407171606
Provider Name (Legal Business Name): JORDAN D SMITH PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LONG COVE CT
GREENSBORO NC
27407-5843
US

IV. Provider business mailing address

4 LONG COVE CT
GREENSBORO NC
27407-5843
US

V. Phone/Fax

Practice location:
  • Phone: 336-878-6000
  • Fax:
Mailing address:
  • Phone: 336-878-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-14265
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2009017116
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number20783
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: