Provider Demographics
NPI:1215360243
Name:PROCTOR, JORDAN STEPHEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:STEPHEN
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3668 S DALLAS ST
Mailing Address - Street 2:210
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-7439
Mailing Address - Country:US
Mailing Address - Phone:720-231-3967
Mailing Address - Fax:
Practice Address - Street 1:3668 S DALLAS ST
Practice Address - Street 2:210
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-7439
Practice Address - Country:US
Practice Address - Phone:720-231-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist