Provider Demographics
NPI:1437178142
Name:JORDAN, NANCY KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:KAY
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23302 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9421
Mailing Address - Country:US
Mailing Address - Phone:509-255-6547
Mailing Address - Fax:
Practice Address - Street 1:5901 N LIDGERWOOD ST
Practice Address - Street 2:SUITE 128
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5095
Practice Address - Country:US
Practice Address - Phone:509-482-3057
Practice Address - Fax:509-482-3058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist