MEDICARE: JORDAN SIEMBOR 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
1	1835P2201X	Ambulatory Care Pharmacist	PCT.00149446	CT

General Provider Information

NPI Number	:	1306594585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN SIEMBOR PHARMD

Provider Business Mailing Address
First Line	:	30 OUTLOOK AVE APT 105
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 HOWARD AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-1300
Country	:	US
Telephone Number	:	888-461-0106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	03/16/2022

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