Provider Demographics
NPI:1659681195
Name:RICARD, JORDAN SCOTT (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:SCOTT
Last Name:RICARD
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 1:1710 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2302
Mailing Address - Country:US
Mailing Address - Phone:719-589-3633
Mailing Address - Fax:
Practice Address - Street 1:1710 1ST ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2302
Practice Address - Country:US
Practice Address - Phone:719-589-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist