Provider Demographics
NPI:1740775485
Name:JORDAN, CASSIE (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N ARMISTEAD AVE LOT 154
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1683
Mailing Address - Country:US
Mailing Address - Phone:804-239-4619
Mailing Address - Fax:
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2353
Practice Address - Country:US
Practice Address - Phone:717-765-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist