Provider Demographics
NPI:1063028892
Name:THOMPSON, JORDAN IRENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:IRENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14302 FERNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6339
Mailing Address - Country:US
Mailing Address - Phone:714-618-8766
Mailing Address - Fax:
Practice Address - Street 1:15141 WHITTIER BLVD STE 260
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2175
Practice Address - Country:US
Practice Address - Phone:562-693-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH81408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist