Provider Demographics
NPI:1649843780
Name:PARKE, JORDAN LANE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LANE
Last Name:PARKE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1719
Mailing Address - Country:US
Mailing Address - Phone:240-357-5782
Mailing Address - Fax:
Practice Address - Street 1:3137 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8134
Practice Address - Country:US
Practice Address - Phone:406-652-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-79470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist