Provider Demographics
NPI:1194098020
Name:CARVER, JORDAN SCOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:SCOTT
Last Name:CARVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 RENAISSANCE TOWNE DR
Mailing Address - Street 2:#104
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7667
Mailing Address - Country:US
Mailing Address - Phone:801-295-6979
Mailing Address - Fax:801-295-6989
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR
Practice Address - Street 2:#104
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7667
Practice Address - Country:US
Practice Address - Phone:801-295-6979
Practice Address - Fax:801-295-6989
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6094265-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6094265-1701OtherSTATE OF UTAH