Provider Demographics
NPI:1710615513
Name:VERBEKE, JORDIN TAYLOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JORDIN
Middle Name:TAYLOR
Last Name:VERBEKE
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 1:78 S ELK ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1354
Mailing Address - Country:US
Mailing Address - Phone:810-648-2265
Mailing Address - Fax:
Practice Address - Street 1:78 S ELK ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1354
Practice Address - Country:US
Practice Address - Phone:810-648-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist