Healthcare Provider Details

I. General information

NPI: 1033862719
Provider Name (Legal Business Name): JORDAN BRADLEY ABEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 W SUNSET BLVD
ST GEORGE UT
84770-6587
US

IV. Provider business mailing address

276 S 2670 E
ST GEORGE UT
84790-6412
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-9781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10439337-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: