Provider Demographics
NPI:1629666748
Name:CLINE, JORDAN ERICA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ERICA
Last Name:CLINE
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 1:50875 ZEP RD W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43772-9627
Mailing Address - Country:US
Mailing Address - Phone:740-509-0705
Mailing Address - Fax:
Practice Address - Street 1:1116 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2508
Practice Address - Country:US
Practice Address - Phone:740-439-3502
Practice Address - Fax:740-439-6656
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist