Individual
CARL RICHARD JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
302 HARBOR POINTE DR, EAST PEORIA, IL 61611-5802
(309) 698-1050
Mailing address
302 HARBOR POINTE DR, EAST PEORIA, IL 61611-5802
(309) 698-1050
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051027221
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051027221
PHARMACIST REGISTRATION
IL
Enumeration date
03/28/2007
Last updated
07/08/2007
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