Healthcare Provider Details

I. General information

NPI: 1487123188
Provider Name (Legal Business Name): JORDAN MICHEL FIKE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ROOSEVELT AVE
YORK PA
17408-8506
US

IV. Provider business mailing address

255 CALLIE DRIVE
YORK PA
17404
US

V. Phone/Fax

Practice location:
  • Phone: 717-767-7009
  • Fax:
Mailing address:
  • Phone: 412-496-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP451498
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: