Active NPI
Jordan Michael Pelton, PHARMD
- Pharmacist
- Fort Wayne, IN
National Provider Identifier
1366069379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302042475
- Practice address
- 2121 Lake Ave
Fort Wayne, IN 46805-5100 - Phone
- (260) 426-5431
- NPI assigned
- Jun 25, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302042475 | MI | Primary |
Addresses
Primary practice location
2121 Lake Ave
Fort Wayne, IN 46805-5100
Mailing address
9601 Fenwick LN
New Haven, IN 46774-1667
Phone (419) 203-4351
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 |
|---|---|---|---|
| 5302042475 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593043200000",
"number": "1366069379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9601 FENWICK LN",
"city": "NEW HAVEN",
"state": "IN",
"postal_code": "467741667",
"telephone_number": "419-203-4351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 LAKE AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055100",
"telephone_number": "260-426-5431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELTON",
"first_name": "JORDAN",
"middle_name": "MICHAEL",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-25",
"last_updated": "2020-06-25",
"certification_date": "2020-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302042475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.