Provider Demographics
NPI:1952587917
Name:JORDAN, RONALD J (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
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 1:2040 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5012
Mailing Address - Country:US
Mailing Address - Phone:518-869-0702
Mailing Address - Fax:518-456-8761
Practice Address - Street 1:2040 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5012
Practice Address - Country:US
Practice Address - Phone:518-869-0702
Practice Address - Fax:518-456-8761
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035441-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist