Active NPI
Robert Mark Jordan, PHARM D
- Pharmacist
- Clinton, MS
National Provider Identifier
1003184417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E09972
- Practice address
- 204 Highway 80 E
Clinton, MS 39056-4716 - Phone
- (601) 926-1179
- NPI assigned
- Dec 13, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | E-09972 | MS | |
| Pharmacist | 183500000X | E09972 | MS | Primary |
Addresses
Primary practice location
204 Highway 80 E
Clinton, MS 39056-4716
Mailing address
PO Box 398
Flora, MS 39071-0398
Phone (601) 665-2299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E09972 | MS | MD | Pharmacist |
| E-09972 | MS | MD | Ambulatory Care Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Corner Pharmacy and Market | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Retail Pharmacy
- Flora, MS
- NPI 1467188029
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679529600000",
"number": "1003184417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 398",
"city": "FLORA",
"state": "MS",
"postal_code": "390710398",
"telephone_number": "601-665-2299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 HIGHWAY 80 E",
"city": "CLINTON",
"state": "MS",
"postal_code": "390564716",
"telephone_number": "601-926-1179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "ROBERT",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-13",
"last_updated": "2023-03-23",
"certification_date": "2022-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "MS",
"license": "E-09972",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E09972",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.