Provider Demographics
NPI:1053035113
Name:JORDAN DRUGS, LLC
Entity type:Organization
Organization Name:JORDAN DRUGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:810-265-2121
Mailing Address - Street 1:10188 STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9259
Mailing Address - Country:US
Mailing Address - Phone:810-265-2121
Mailing Address - Fax:
Practice Address - Street 1:124 W STATE ST STE B
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457-7716
Practice Address - Country:US
Practice Address - Phone:810-265-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy