Provider Demographics
NPI:1114484557
Name:KUBAS, JORDAN ASHLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ASHLEY
Last Name:KUBAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:ASHLEY
Other - Last Name:MANUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:430 ASCENT DR APT 15105
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6868
Mailing Address - Country:US
Mailing Address - Phone:412-491-0580
Mailing Address - Fax:
Practice Address - Street 1:550 GRANDVIEW CROSSING DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-7100
Practice Address - Country:US
Practice Address - Phone:724-799-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP452468OtherSTATE BOARD OF PHARMACY LICENSE