Provider Demographics
NPI:1891408217
Name:CASSELL, JORDAN LEE (CPHT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:CASSELL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:140 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-2001
Mailing Address - Country:US
Mailing Address - Phone:719-424-8043
Mailing Address - Fax:
Practice Address - Street 1:553 E BLEDSOE ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3003
Practice Address - Country:US
Practice Address - Phone:719-424-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000076784183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician