Provider Demographics
NPI:1659034643
Name:YOUNG, JORDAN MACKENZIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:MACKENZIE
Last Name:YOUNG
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:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:AR
Mailing Address - Zip Code:71663-0073
Mailing Address - Country:US
Mailing Address - Phone:870-737-3224
Mailing Address - Fax:
Practice Address - Street 1:105 HIGHWAY 165 S
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:AR
Practice Address - Zip Code:71663-9251
Practice Address - Country:US
Practice Address - Phone:870-737-2813
Practice Address - Fax:870-737-2781
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist