Healthcare Provider Details

I. General information

NPI: 1831794700
Provider Name (Legal Business Name): ALYSSA NICOLE JORDAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 W MARKET ST
TIFFIN OH
44883-2521
US

IV. Provider business mailing address

790 W MARKET ST
TIFFIN OH
44883-2521
US

V. Phone/Fax

Practice location:
  • Phone: 419-447-8304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03438196
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: