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NPI Code Detail

MEDICARE: JORDAN NICOLE SPEEDY PHARMD

MEDICARE: JORDAN NICOLE SPEEDY PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist26028206AIN

General Provider Information

NPI Number : 1104472828
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN NICOLE SPEEDY PHARMD
Provider Business Mailing Address
First Line : 3705 KENTUCKY AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46221-2703
Country : US
Telephone Number : 317-856-1253
Fax Number :
Provider Business Practice Location Address
First Line : 3705 KENTUCKY AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46221-2703
Country : US
Telephone Number : 317-856-1253
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2019
Last Update Date : 08/19/2019

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