Provider Demographics
NPI:1114225505
Name:JORDAN, TERESA FREEMAN (RPH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:FREEMAN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 HORSESHOE POINT RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23432-1835
Mailing Address - Country:US
Mailing Address - Phone:757-714-0151
Mailing Address - Fax:
Practice Address - Street 1:1200 BENNS CHURCH BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-6063
Practice Address - Country:US
Practice Address - Phone:757-357-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist