Provider Demographics
NPI:1184052706
Name:JORDAN, ADAM (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6309
Mailing Address - Country:US
Mailing Address - Phone:207-992-4458
Mailing Address - Fax:207-992-4460
Practice Address - Street 1:210 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5411
Practice Address - Country:US
Practice Address - Phone:207-992-4458
Practice Address - Fax:207-992-4460
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist