Provider Demographics
NPI:1376686071
Name:JORDAN, LAURA KOZOYED (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KOZOYED
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:KOZOYED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:231 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1003
Mailing Address - Country:US
Mailing Address - Phone:757-613-1583
Mailing Address - Fax:
Practice Address - Street 1:231 E 39TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1003
Practice Address - Country:US
Practice Address - Phone:757-613-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202009102OtherPHARMACY LICENSE