Provider Demographics
NPI:1922696707
Name:JORDAN, JON ERIC
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:ERIC
Last Name:JORDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-1828
Mailing Address - Country:US
Mailing Address - Phone:301-834-9715
Mailing Address - Fax:301-834-4414
Practice Address - Street 1:610 9TH AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MD
Practice Address - Zip Code:21716-1828
Practice Address - Country:US
Practice Address - Phone:301-834-9715
Practice Address - Fax:301-834-4414
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119053OtherNABP
922221OtherNPI