Healthcare Provider Details

I. General information

NPI: 1205485448
Provider Name (Legal Business Name): JORDAN MEFFORD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 07/17/2022
Certification Date: 07/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 DEWAR DR
ROCK SPRINGS WY
82901-5810
US

IV. Provider business mailing address

515 CONNECTICUT PL
GREEN RIVER WY
82935-6024
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-9734
  • Fax: 307-362-1380
Mailing address:
  • Phone: 307-871-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4163
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: