Jordan Mark Warren

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

PST.024964 Issued in LA

Practice address

1125 Highway 80
Haughton, LA 71037-9430

Phone

(318) 949-8476

NPI assigned

Jul 26, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1184397192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 HIGHWAY 80",
            "city": "HAUGHTON",
            "state": "LA",
            "postal_code": "710379430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 HIGHWAY 80",
            "city": "HAUGHTON",
            "state": "LA",
            "postal_code": "710379430",
            "telephone_number": "318-949-8476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12125 Highway 90",
            "address_purpose": "LOCATION",
            "city": "Luling",
            "state": "LA",
            "postal_code": "700703000",
            "country_code": "US",
            "telephone_number": "985-785-9054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WARREN",
        "first_name": "JORDAN",
        "middle_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-26",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "LA",
            "license": "PST.024964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Callahan Tullos, M.A. CCC-SLP
• Kristi Lynn Valentine
• Ashley Vaughan
• Walgreen Co
• Shuai Jay Wang
• Lindsey Warren
• Samuel C Whitaker, MSN, FNP-C
• Tanisha Sharda White
• Jared Williams, ATC, NASM-PES
• Andreka Winston

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Haughton, LA
• Providers in Haughton, LA by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.

Verify at the official NPI Registry.