Provider Demographics
NPI:1457354946
Name:JORDAN, JAMES CHARLES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHARLES
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:209 W REGINA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2522
Mailing Address - Country:US
Mailing Address - Phone:509-258-4517
Mailing Address - Fax:509-258-4456
Practice Address - Street 1:6203 AGENCY LOOP ROAD
Practice Address - Street 2:
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040
Practice Address - Country:US
Practice Address - Phone:509-258-4517
Practice Address - Fax:509-258-4456
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00044329183500000X
IDP3958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist