Individual
JORDAN SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
8959 E DRY CREEK RD, CENTENNIAL, CO 80112-2765
(720) 214-1172
Mailing address
3239 S PARKER RD APT 201A, DENVER, CO 80014-3211
(303) 810-6767
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHA.0024593
CO
Other
Enumeration date
09/22/2023
Last updated
09/22/2023
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