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Organization

JORDAN PHARMACY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROY B JORDAN PHARMACIST (OWNER)
(940) 549-1011
Entity
Organization

Contact information

Practice address
1332 HIGHWAY 16 S, GRAHAM, TX 76450-4202
(940) 549-1011
(940) 549-0716
Mailing address
1332 HIGHWAY 16 S, GRAHAM, TX 76450-4202
(940) 549-1011
(940) 549-0716

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
14812
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0102188-01
TX MEDICAID & HEALTHCARE
TX
05
143816
TX
Enumeration date
05/07/2007
Last updated
09/03/2014
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