Provider Demographics
NPI:1396299053
Name:NELSON, JORDYN (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:NELSON
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 1:16300 SE EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9515
Mailing Address - Country:US
Mailing Address - Phone:541-942-7443
Mailing Address - Fax:541-942-7139
Practice Address - Street 1:1500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2208
Practice Address - Country:US
Practice Address - Phone:541-942-7443
Practice Address - Fax:541-942-7139
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0015402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist