DR. SHANE JORDAN (NPI# 1104145606) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104145606 |
| Entity Type | Individual |
| Full Name | DR. SHANE JORDAN |
| Practice Address |
4445 Us Highway 98 N Lakeland FL 33809-0402 |
| Mailing Address |
1834 Grey Fox Dr Lakeland FL 33810-2069 |
| Practice Telephone | 8638152343 |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2010-05-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | PS45173 | FL | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 021624100 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972062495 | Shane Jordan | Behavior Technician | 1819 E Springfield Ave Ste H, Spokane, WA 99202-2954 | 2019-03-14 |
| 1881132132 | Shane Jordan | Physician Assistant | 1285 Beacon St, Brookline, MA 02446-5284 | 2017-02-07 |
| 1982062576 | Shane Jordan | Physician Assistant | 2015 Grand Concourse, Bronx, NY 10453-4303 | 2016-02-10 |
| Street Address |
4445 US HIGHWAY 98 N |
| City | LAKELAND |
| State | FL |
| Zip Code | 33809-0402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275548422 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 4445 Us Highway 98 N, Lakeland, FL 33809-0402 | 2006-07-29 |
| 1639781719 | Katera Kennon | Pharmacist | 4445 Us Highway 98 N, Lakeland, FL 33809-0402 | 2020-08-19 |
| 1619257177 | Pathik Patel | Pharmacist | 4445 Us Highway 98 N, Lakeland, FL 33809-0402 | 2011-08-27 |
| 1518286780 | Manoj Musale | Pharmacist | 4445 Us Highway 98 N, Walgreens, Lakeland, FL 33809-0402 | 2010-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861018178 | John C Gallik | Military Health Care Provider | 3176 Corporal Johnson Road, Jbsa Fort Sam Houston, TX 33809 | 2020-06-23 |
| 1376189209 | Julie Independence Tomchak | Nurse's Aide | 7805 Us Highway Lot 29 # 98 N, Lakeland, FL 33809 | 2019-11-26 |
| 1912465923 | Lakeland Oaks Nh LLC | Skilled Nursing Facility | 855 Carpenters Way, Lakeland, FL 33809 | 2019-03-08 |
| 1235528753 | Christia Mccann | Physician Assistant | 4120 Us Hwy. 98 N., One Lakeland Square, Lakeland, FL 33809 | 2015-01-21 |
| 1548679616 | Ashley Frances Hamarowicz | Physical Therapist | 771 Carpenters Way, Lakeland, FL 33809 | 2014-08-04 |
| 1750700860 | Grace Manor Suites | Assisted Living Facility | 4620 N Socrum Loop Road, Lakeland, FL 33809 | 2014-04-16 |
| 1164769980 | Christopher Fisher | Hearing Instrument Specialist | 3800 North Rd 98, Ste 500, Lakeland, FL 33809 | 2013-01-14 |
| 1023374063 | Eagle Lake Pharmacy Inc | Pharmacy | 5245 A U S Hwy 98 N, Suite A, Lakeland, FL 33809 | 2012-04-04 |
| 1851669675 | Reginald Keith Jenkins | Pharmacist | 1043 Walt Williams Road, Lakeland, FL 33809 | 2011-12-07 |
| 1578859633 | Jill Margaret Waldrop | Pharmacist | 6600 N. Socrum Loop, Lakeland, FL 33809 | 2011-06-27 |
| Find all providers in zip 33809 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497384085 | Rodjsyne Jones | Pharmacist | 350 Eagles Landing Dr, Lakeland, FL 33810-2999 | 2020-04-06 |
| 1487293445 | Pankaj D Patel | Pharmacist | 3656 Frentress Dr, Lakeland, FL 33812-1206 | 2019-12-22 |
| 1598324436 | Wesley Zane Hamlin | Pharmacist | 1324 Lakeland Hills Blvd # 203, Lakeland, FL 33805-4543 | 2019-06-12 |
| 1518422971 | Prime Therapeutic Consulting & Services, LLC | Pharmacist | 120 W Hickory St, Lakeland, FL 33815-4715 | 2019-02-09 |
| 1982103255 | Robert James Fournier | Pharmacist | 2025 Sylvester Rd Unit J2, Lakeland, FL 33803-3577 | 2018-02-01 |
| 1952846685 | Tara Talisea Guyher | Pharmacist | 2576 Boots Rd, Lakeland, FL 33810-5158 | 2017-01-04 |
| 1003288556 | Casey Ray Hanks | Pharmacist | 12360 Lakeland Acres Rd, Lakeland, FL 33810-1016 | 2015-10-23 |
| 1528430238 | Roshan Nathoo | Pharmacist | 7387 Us Highway 98 N, Lakeland, FL 33809-2102 | 2015-10-21 |
| 1760853832 | Cheryl Adele Minozzi | Pharmacist | 5524 Scott View Ln, Lakeland, FL 33813-3064 | 2015-10-14 |
| 1275912073 | Brent Williams | Pharmacist | 2016 Sophia Pl, Lakeland, FL 33811-2684 | 2015-05-26 |
| Find all providers in LAKELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.