Provider Demographics
NPI:1952134843
Name:WHALEY, JORDAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WHALEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 TINSLEY LN
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4820
Mailing Address - Country:US
Mailing Address - Phone:865-654-8699
Mailing Address - Fax:
Practice Address - Street 1:6005 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6346
Practice Address - Country:US
Practice Address - Phone:865-588-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist