Provider Demographics
NPI:1922434059
Name:RUSH, JORDAN COLLIN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:COLLIN
Last Name:RUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 ZANTE CURRANT RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6488
Mailing Address - Country:US
Mailing Address - Phone:336-991-4551
Mailing Address - Fax:608-203-4544
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-5415
Practice Address - Fax:919-966-8065
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist