Provider Demographics
NPI:1205433513
Name:RAUH, JORDAN LECOUR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LECOUR
Last Name:RAUH
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 1:2222 DUNEWOOD PL APT 533
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-2221
Mailing Address - Country:US
Mailing Address - Phone:260-437-1245
Mailing Address - Fax:
Practice Address - Street 1:5349 W PIKE PLAZA RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-3011
Practice Address - Country:US
Practice Address - Phone:317-387-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029031A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist