MEDICARE: JORDAN HERRMAN

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	183500000X	Pharmacist	18528	OK

General Provider Information

NPI Number	:	1336790054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN HERRMAN

Provider Business Mailing Address
First Line	:	8106 S JUNIPER PL
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74011-6455
Country	:	US
Telephone Number	:	918-606-7257
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-7412
Country	:	US
Telephone Number	:	918-494-4040
Fax Number	:

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

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	09/24/2019

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Directions to “ JORDAN HERRMAN ” Practice Location

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