Provider Demographics
NPI:1972093391
Name:MYERS, JORDAN CORINNE (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:CORINNE
Last Name:MYERS
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7008
Mailing Address - Country:US
Mailing Address - Phone:530-543-5883
Mailing Address - Fax:530-541-7940
Practice Address - Street 1:2170 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7008
Practice Address - Country:US
Practice Address - Phone:530-543-5883
Practice Address - Fax:530-541-7940
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician