Provider Demographics
NPI:1164137154
Name:BURKDOLL, JORDAN SHAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:SHAE
Last Name:BURKDOLL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 FEDERAL DR
Mailing Address - Street 2:ATTN: IHSC PHARMACY
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1094
Mailing Address - Country:US
Mailing Address - Phone:585-344-6646
Mailing Address - Fax:
Practice Address - Street 1:4250 FEDERAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1094
Practice Address - Country:US
Practice Address - Phone:585-344-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0024264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist