Provider Demographics
NPI:1073922050
Name:CAMPBELL, JORDAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:952 SWEDE GULCH RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-3713
Mailing Address - Country:US
Mailing Address - Phone:303-526-2334
Mailing Address - Fax:
Practice Address - Street 1:952 SWEDE GULCH RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-3713
Practice Address - Country:US
Practice Address - Phone:303-526-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3760183500000X
CO22679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist