Healthcare Provider Details

I. General information

NPI: 1942982343
Provider Name (Legal Business Name): JORDAN OLIVIA FYOCK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 GALLERIA DR
JOHNSTOWN PA
15904-8900
US

IV. Provider business mailing address

1398 OLD FORBES RD
STOYSTOWN PA
15563-8765
US

V. Phone/Fax

Practice location:
  • Phone: 814-943-8164
  • Fax:
Mailing address:
  • Phone: 814-659-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP456943
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: