Provider Demographics
NPI:1558912733
Name:NELSON, JORDAN THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:THOMAS
Last Name:NELSON
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 1:256 PRINCE AVE UNIT 421
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5733
Mailing Address - Country:US
Mailing Address - Phone:252-288-1230
Mailing Address - Fax:
Practice Address - Street 1:2330 YEW ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-3942
Practice Address - Country:US
Practice Address - Phone:360-734-5413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60953959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist