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General NPI Number Information
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NPI Number | 1407239411
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Entity Type | Individual
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Provider Name | TRACEY JORDAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 10/01/2022
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Provider Practice Location Address
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Address Line | 105 OAKLEY DR
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City | NEW BERN
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State | NC
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Zip | 28560-7059
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Country | US
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Telephone | 810-265-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 10188 STANLEY RD
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City | FLUSHING
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State | MI
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Zip | 48433-9259
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Country | US
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Telephone | 810-265-2121
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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 | 25153
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License Number State | NC
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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 | 5302047388
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License Number State | MI
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