Provider Demographics
NPI:1891463105
Name:MARTIN, JORDAN CAROLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:CAROLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:CAROLE
Other - Last Name:STUBBLEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7590 HIGHWAY 351
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8226
Mailing Address - Country:US
Mailing Address - Phone:870-530-5128
Mailing Address - Fax:
Practice Address - Street 1:2802 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2617
Practice Address - Country:US
Practice Address - Phone:870-236-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist