Provider Demographics
NPI:1407171606
Name:SMITH, JORDAN D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:D
Last Name:SMITH
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 1:4 LONG COVE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5843
Mailing Address - Country:US
Mailing Address - Phone:336-878-6000
Mailing Address - Fax:
Practice Address - Street 1:4 LONG COVE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5843
Practice Address - Country:US
Practice Address - Phone:336-878-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14265183500000X
MO20090171161835P1200X
NC207831835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy