Provider Demographics
NPI:1316251804
Name:JORDEN, PAMELA (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:JORDEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 MAGNOLIA LEAF LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2730
Mailing Address - Country:US
Mailing Address - Phone:810-814-2763
Mailing Address - Fax:
Practice Address - Street 1:7616 MAGNOLIA LEAF LN
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2730
Practice Address - Country:US
Practice Address - Phone:810-814-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034060183500000X
MI5302022839183500000X
TX37576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist