Provider Demographics
NPI:1093165235
Name:JORDAN, ELIZABETH DIAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DIAL
Last Name:JORDAN
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 1:414 N CRAFT HWY
Mailing Address - Street 2:
Mailing Address - City:CHICKASAW
Mailing Address - State:AL
Mailing Address - Zip Code:36611-1312
Mailing Address - Country:US
Mailing Address - Phone:251-452-0531
Mailing Address - Fax:251-456-1529
Practice Address - Street 1:414 N CRAFT HWY
Practice Address - Street 2:
Practice Address - City:CHICKASAW
Practice Address - State:AL
Practice Address - Zip Code:36611-1312
Practice Address - Country:US
Practice Address - Phone:251-452-0531
Practice Address - Fax:251-456-1529
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS39299OtherREGISTERED PHARMACIST- INACTIVE STATUS
AL14372OtherREGISTERED PHARMACIST