Provider Demographics
NPI:1881936813
Name:MILLHAM, JORDAN CHRISTOPHER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:CHRISTOPHER
Last Name:MILLHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 N PROSPECT AVE
Mailing Address - Street 2:#706
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1260
Mailing Address - Country:US
Mailing Address - Phone:314-482-5249
Mailing Address - Fax:414-456-1709
Practice Address - Street 1:2275A N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2207
Practice Address - Country:US
Practice Address - Phone:414-456-1701
Practice Address - Fax:414-456-1709
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-16
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16626-40183500000X
IL051.295678183500000X
MO2008018173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist