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General NPI Number Information
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NPI Number | 1225558018
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Entity Type | Individual
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Provider Name | JORDAN WALKER
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Gender | Female
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 2098 E FIRE TOWER RD
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City | GREENVILLE
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State | NC
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Zip | 27858-4134
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Country | US
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Telephone | 252-756-9272
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Fax |
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Provider Business Mailing Address
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Address Line | 408 QUAIL HILL ST
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-2097
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Country | US
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Telephone | 740-479-2849
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26952
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License Number State | NC
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