Provider Demographics
NPI:1053142323
Name:POWELL, JORDAN MCKENZIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MCKENZIE
Last Name:POWELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RAMSGATE GARDENS CT APT 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3568
Mailing Address - Country:US
Mailing Address - Phone:502-645-4019
Mailing Address - Fax:
Practice Address - Street 1:4211 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1619
Practice Address - Country:US
Practice Address - Phone:502-363-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program