Provider Demographics
NPI:1124196274
Name:JORDRE, ANN MARIE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:JORDRE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2914
Mailing Address - Country:US
Mailing Address - Phone:605-224-0122
Mailing Address - Fax:
Practice Address - Street 1:120 W SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2425
Practice Address - Country:US
Practice Address - Phone:605-224-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist