Provider Demographics
NPI:1154743904
Name:JORDAN, JEFFREY JEROME (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JEROME
Last Name:JORDAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT 940 MT. POCONO PLAZA
Mailing Address - Street 2:WEIS PHARMACY
Mailing Address - City:MT. POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344
Mailing Address - Country:US
Mailing Address - Phone:570-839-6240
Mailing Address - Fax:
Practice Address - Street 1:RT 940 MT POCONO PLAZA
Practice Address - Street 2:WEIS PHARMACY
Practice Address - City:MT. POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344
Practice Address - Country:US
Practice Address - Phone:570-839-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-035354-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist