Provider Demographics
NPI:1831344761
Name:JORDAN, KELLI LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:LYNN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70431 HIGHWAY 21
Mailing Address - Street 2:WINN DIXIE
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8103
Mailing Address - Country:US
Mailing Address - Phone:985-898-1195
Mailing Address - Fax:985-871-8151
Practice Address - Street 1:70431 HIGHWAY 21
Practice Address - Street 2:WINN DIXIE
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8103
Practice Address - Country:US
Practice Address - Phone:985-898-1195
Practice Address - Fax:985-871-8151
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15905183500000X
LA19056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist