Provider Demographics
NPI:1740336809
Name:JORDAN, ALLEN HUGH (RPH)
Entity type:Individual
Prefix:MRS
First Name:ALLEN
Middle Name:HUGH
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451-0069
Mailing Address - Country:US
Mailing Address - Phone:251-275-1000
Mailing Address - Fax:251-275-1003
Practice Address - Street 1:210 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-3232
Practice Address - Country:US
Practice Address - Phone:251-275-1000
Practice Address - Fax:251-275-1003
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist