MEDICARE: JORDAN BROCK

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	025238	KY

General Provider Information

NPI Number	:	1780534107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN BROCK

Provider Business Mailing Address
First Line	:	1 TRILLIUM WAY
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-8426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TRILLIUM WAY
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-8426
Country	:	US
Telephone Number	:	606-526-4652
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ JORDAN BROCK ” Practice Location

Language	Start Address	Practice Location

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