Provider Demographics
NPI:1972901932
Name:GREENE, JORDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDON
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 PAPER MOON DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1404
Mailing Address - Country:US
Mailing Address - Phone:217-725-4433
Mailing Address - Fax:
Practice Address - Street 1:527 E BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2915
Practice Address - Country:US
Practice Address - Phone:254-527-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist