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General NPI Number Information
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NPI Number | 1003184417
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Entity Type | Individual
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Provider Name | ROBERT MARK JORDAN PHARM D
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Gender | Male
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 204 HIGHWAY 80 E
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City | CLINTON
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State | MS
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Zip | 39056-4716
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Country | US
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Telephone | 601-926-1179
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 398
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City | FLORA
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State | MS
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Zip | 39071-0398
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Country | US
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Telephone | 601-665-2299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | E-09972
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E09972
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License Number State | MS
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