Individual
JORDAN LUKE ELLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
Mailing address
500 INDIANA AVE, WINSLOW, AZ 86047-2169
(928) 289-4646
(928) 289-6293
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
022691
AZ
Other
Enumeration date
08/16/2017
Last updated
08/13/2025
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