Healthcare Provider Details

I. General information

NPI: 1023141934
Provider Name (Legal Business Name): PATTI MAE JORDAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATTI MAE BARLEY PHARMD

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 WHITNEY AVE
MEMPHIS TN
38127-6662
US

IV. Provider business mailing address

2150 WHITNEY AVE
MEMPHIS TN
38127-6662
US

V. Phone/Fax

Practice location:
  • Phone: 901-353-5440
  • Fax: 901-353-5464
Mailing address:
  • Phone: 901-353-5440
  • Fax: 901-353-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number0000003641
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: