Provider Demographics
NPI:1154042968
Name:TAIT, JORDAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:TAIT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 N SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2726
Mailing Address - Country:US
Mailing Address - Phone:724-972-9340
Mailing Address - Fax:
Practice Address - Street 1:105 GAMMA DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2963
Practice Address - Country:US
Practice Address - Phone:412-449-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist