Jordan Stephen Proctor, PHARM.D.
Individual provider Active NPI Pharmacist · Aurora, CO
NPI 1215360243 · NPPES record last updated Aug 13, 2013
Key facts
- NPI
- 1215360243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 19977 (CO)
- Practice address
- 3668 S Dallas St
210
Aurora, CO 80014-7439 - Phone
- (720) 231-3967
- NPI assigned
- Aug 13, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19977 | CO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19977 | CO | Yes |
Addresses
Primary practice location
3668 S Dallas St
210
Aurora, CO 80014-7439
Mailing address
3668 S Dallas St
210
Aurora, CO 80014-7439
Phone (720) 231-3967
Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.