Healthcare Provider Details

I. General information

NPI: 1841155124
Provider Name (Legal Business Name): JORDAN HUMPHREY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12606 E MISSION AVE
SPOKANE VALLEY WA
99216-3421
US

IV. Provider business mailing address

1413 W GIBBS RD
SPOKANE WA
99224-9245
US

V. Phone/Fax

Practice location:
  • Phone: 509-924-6650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.70005439
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: