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General NPI Number Information
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NPI Number | 1467912311
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Entity Type | Individual
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Provider Name | ALICIA NICOLE JORDAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 05/28/2022
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Provider Practice Location Address
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Address Line | 2639 LAWNDALE DR
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City | GREENSBORO
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State | NC
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Zip | 27408-4802
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Country | US
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Telephone | 336-545-1083
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Fax |
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Provider Business Mailing Address
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Address Line | 3214 BRASSFIELD RD APT 3203
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City | GREENSBORO
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State | NC
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Zip | 27410-9452
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Country | US
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Telephone | 304-941-6519
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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 | 38006
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License Number State | SC
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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 | 27338
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License Number State | NC
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