Provider Demographics
NPI:1295226348
Name:JORDAN, HALEY MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:JORDAN
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 1:512 MARKET ST NE APT 9
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-1978
Mailing Address - Country:US
Mailing Address - Phone:256-318-2794
Mailing Address - Fax:
Practice Address - Street 1:310 PELHAM AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5016
Practice Address - Country:US
Practice Address - Phone:256-534-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL17654OtherPHARMACIST LICENSE