Provider Demographics
NPI:1093847626
Name:JANDORA, JEFFREY STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:JANDORA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 GINSENG WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3878
Mailing Address - Country:US
Mailing Address - Phone:928-771-2784
Mailing Address - Fax:928-771-2784
Practice Address - Street 1:5709 GINSENG WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3878
Practice Address - Country:US
Practice Address - Phone:928-771-2784
Practice Address - Fax:928-771-2784
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9297183500000X
WAPH00011083183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist