Provider Demographics
NPI:1225619695
Name:NAVALLE, JORDAN ALEXANDRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ALEXANDRA
Last Name:NAVALLE
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 1:201 ASHLER DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5348
Mailing Address - Country:US
Mailing Address - Phone:864-270-5161
Mailing Address - Fax:
Practice Address - Street 1:14900 JONES MALTSBERGER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3919
Practice Address - Country:US
Practice Address - Phone:210-496-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42731183500000X
NC30086183500000X
GARPH032571183500000X
TX69239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist