Individual
JORDAN LEIGH HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11109 PARKVIEW PLAZA DR # 1, FORT WAYNE, IN 46845-1701
(260) 266-3080
Mailing address
225 FOXCROFT RD, LEXINGTON, OH 44904-9725
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
03439309
OH
183500000X
Pharmacist
26028699A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03439309
OHIO PHARMACIST LICENSE
OH
01
—
26028699A
INDIANA PHARMACY LICENSE
IN
Enumeration date
08/21/2020
Last updated
08/21/2020
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