Provider Demographics
NPI:1265055479
Name:CLOONAN, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CLOONAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-6134
Mailing Address - Country:US
Mailing Address - Phone:216-369-2200
Mailing Address - Fax:
Practice Address - Street 1:8269 EMERALD GLEN CT
Practice Address - Street 2:
Practice Address - City:KIRTLAND
Practice Address - State:OH
Practice Address - Zip Code:44094-9745
Practice Address - Country:US
Practice Address - Phone:440-567-6483
Practice Address - Fax:855-355-3480
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183700000X
OH034422991835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183700000XPharmacy Service ProvidersPharmacy Technician