Provider Demographics
NPI:1467912311
Name:JORDAN, ALICIA NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:NICOLE
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 1:3214 BRASSFIELD RD APT 3203
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9452
Mailing Address - Country:US
Mailing Address - Phone:304-941-6519
Mailing Address - Fax:
Practice Address - Street 1:2639 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4802
Practice Address - Country:US
Practice Address - Phone:336-545-1083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38006183500000X
NC27338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist