Provider Demographics
NPI:1760162143
Name:JORDAN, DYLAN SCOTT (PHARM D)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:SCOTT
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 N CENTRAL AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1332
Mailing Address - Country:US
Mailing Address - Phone:602-313-2042
Mailing Address - Fax:602-313-2044
Practice Address - Street 1:2302 N CENTRAL AVE STE 7
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1332
Practice Address - Country:US
Practice Address - Phone:602-313-2042
Practice Address - Fax:602-313-2044
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist