Provider Demographics
NPI:1598951709
Name:JORDAN, MARNIE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 188TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6088
Mailing Address - Country:US
Mailing Address - Phone:425-406-5392
Mailing Address - Fax:425-406-5383
Practice Address - Street 1:8629 120TH AVE NE
Practice Address - Street 2:PHARMACY
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5822
Practice Address - Country:US
Practice Address - Phone:425-822-0414
Practice Address - Fax:425-822-0811
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000212221835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist