Provider Demographics
NPI:1093310005
Name:TECKMEYER, JORDAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:TECKMEYER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 TUSCARAWAS ST W
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4750
Mailing Address - Country:US
Mailing Address - Phone:330-453-4845
Mailing Address - Fax:330-453-5476
Practice Address - Street 1:2210 TUSCARAWAS ST W
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4750
Practice Address - Country:US
Practice Address - Phone:330-453-4845
Practice Address - Fax:330-453-5476
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03233686OtherOHIO PHARMACIST LICENSE