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General NPI Number Information
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NPI Number | 1760938310
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Entity Type | Individual
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Provider Name | MARK JORDAN PHARMACY GRADUATE
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 5719 US 23
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City | OSCODA
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State | MI
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Zip | 48750
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Country | US
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Telephone | 989-739-1485
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Fax |
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Provider Business Mailing Address
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Address Line | 115 EAST DIVISION AVENUE
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City | OSCODA
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State | MI
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Zip | 48750
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Country | US
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Telephone | 231-903-9349
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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 | 5302041217
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License Number State | MI
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