Provider Demographics
NPI:1942982343
Name:FYOCK, JORDAN OLIVIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:OLIVIA
Last Name:FYOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 OLD FORBES RD
Mailing Address - Street 2:
Mailing Address - City:STOYSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15563-8765
Mailing Address - Country:US
Mailing Address - Phone:814-659-3676
Mailing Address - Fax:
Practice Address - Street 1:598 GALLERIA DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-8900
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist