Healthcare Provider Details

I. General information

NPI: 1700493459
Provider Name (Legal Business Name): JORDAN LEIGH HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 GORDON COOPER DR
SHAWNEE OK
74801-9005
US

IV. Provider business mailing address

2029 GORDON COOPER DR
SHAWNEE OK
74801-9005
US

V. Phone/Fax

Practice location:
  • Phone: 405-878-5859
  • Fax: 405-669-3099
Mailing address:
  • Phone: 405-878-5859
  • Fax: 405-669-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18933
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: