Provider Demographics
NPI:1679914634
Name:PROPST, JORDAN MARCUS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MARCUS
Last Name:PROPST
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 1:3799 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERRILLS FORD
Mailing Address - State:NC
Mailing Address - Zip Code:28673-9705
Mailing Address - Country:US
Mailing Address - Phone:864-490-7827
Mailing Address - Fax:
Practice Address - Street 1:21500 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6577
Practice Address - Country:US
Practice Address - Phone:704-655-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-07
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist