Jordan Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

21958 Issued in TX

Legal business name

JORDAN PHARMACY INC

Doing business as

Jordan Pharmacy

Practice address

107 N Rice St
Hamilton, TX 76531-1857

Phone

(254) 386-3111

Fax

(254) 386-8844

NPI assigned

Sep 20, 2006

Last updated

Apr 14, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jan Pattillo, RPHNPI 1972159614

Title

Owner

Phone

(254) 386-3111

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• JORDAN PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jan Holley Pattillo, RPH

  • Pharmacist
  • Hamilton, TX
  • NPI 1972159614
  NPD Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492128000000",
    "number": "1578660411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 N RICE ST",
            "city": "HAMILTON",
            "state": "TX",
            "postal_code": "765311857",
            "telephone_number": "254-386-3111",
            "fax_number": "254-386-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N RICE ST",
            "city": "HAMILTON",
            "state": "TX",
            "postal_code": "765311857",
            "telephone_number": "254-386-3111",
            "fax_number": "254-386-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2017-04-14",
        "status": "A",
        "authorized_official_last_name": "PATTILLO",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "254-386-3111",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "21958",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2096994",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0145199",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JORDAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Christine Hopper, MS CCC-SLP
• Monte Harold Horne, MD
• Felicia Annette Inman, LMSW
• J&S Legacy Partners, LLC (CCS Medical Equipment)
• Charles Franklin Johnson, M.D.
• Yvonne Ozioma Joseph, APRN PMHNP-BC
• Patricia Ann Keekley, LPC
• Luke Martin Killian, MD
• Cindy Denise Kinsey, R.PH.
• Linda Catherine Kolodziej, LPC

• Community/Retail Pharmacy in Hamilton, TX
• Providers in Hamilton, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.