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General NPI Number Information
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NPI Number | 1982817102
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Entity Type | Organization
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Legal Business Name | JORDAN PHARMACY
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 1332 HIGHWAY 16 S
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City | GRAHAM
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State | TX
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Zip | 76450-4202
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Country | US
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Telephone | 940-549-1011
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Fax | 940-549-0716
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Provider Business Mailing Address
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Address Line | 1332 HIGHWAY 16 S
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City | GRAHAM
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State | TX
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Zip | 76450-4202
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Country | US
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Telephone | 940-549-1011
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Fax | 940-549-0716
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Authorized Official
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Title or Position | OWNER
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Name | ROY B JORDAN
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Credential | PHARMACIST
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Telephone | 940-549-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 14812
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License Number State | TX
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