NPIMap

Organization Active NPI

Anthony L. Jordan Health Corporation

Doing business as Jordan Health Pharmacy

  • Community/Retail Pharmacy
  • Rochester, NY
National Provider Identifier
1619758968
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
ANTHONY L. JORDAN HEALTH CORPORATION
Doing business as
Jordan Health Pharmacy
Practice address
82 Holland St Ste 100
Rochester, NY 14605-2131
Phone
(585) 719-1932
Fax
(585) 719-1958
NPI assigned
Oct 12, 2023
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ANTHONY L. JORDAN HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Dr. Linda L Clark, MD
Title
President/Ceo
Phone
(585) 423-2870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

82 Holland St Ste 100
Rochester, NY 14605-2131

Mailing address

214C Lake Ave
Rochester, NY 14608-1208
Phone (585) 784-5918

Other identifiers 1

IdentifierTypeStateIssuer
040614OtherNYSTATE LICENSE

Other names 1

  • Jordan Health Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240404002936 NY Part B Supplier - Pharmacy 8729079785 Practice locations: Rochester, NY
O20250401000496 NY DME Supplier - Pharmacy 8729079785 Practice locations: Rochester, NY

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Anthony L. Jordan Health Corporatio82 Holland St, Rochester, NY 14605-2131(585) 719-1932 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Oct 1, 1984

National Provider Directory

National Provider Directory
Tax ID family
Anthony L Jordan HLTH C7 organizations share this tax ID, including this one
Part of
Anthony L Jordan HLTH C

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anthony L. Jordan Health CorporationRochester, NY, CCN 331027 Federally qualified health center Operational/Managerial Control Nov 1, 2010
Woodward CenterRochester, NY, CCN 331044 Federally qualified health center Operational/Managerial Control Aug 27, 2011

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1697068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1619758968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214C LAKE AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146081208",
            "telephone_number": "585-784-5918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 HOLLAND ST STE 100",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146052131",
            "telephone_number": "585-719-1932",
            "fax_number": "585-719-1958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "enumeration_date": "2023-10-12",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "585-423-2870",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "040614",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jordan Health Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.