Healthcare Provider Details

I. General information

NPI: 1689159642
Provider Name (Legal Business Name): JORDAN CELEST HAYGOOD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PRESIDENT ST
CHARLESTON SC
29425-5712
US

IV. Provider business mailing address

422 ROPER POND CIR
COLUMBIA SC
29206-1754
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-5952
  • Fax: 843-792-5954
Mailing address:
  • Phone: 706-631-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number36810
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: