Provider Demographics
NPI:1013532217
Name:WHEELER, JORDAN ELISHA
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELISHA
Last Name:WHEELER
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 1:5000 BRANDT PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6108
Mailing Address - Country:US
Mailing Address - Phone:937-236-0495
Mailing Address - Fax:937-236-1398
Practice Address - Street 1:5000 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-6108
Practice Address - Country:US
Practice Address - Phone:937-236-0495
Practice Address - Fax:937-236-1398
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03134834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist