Basic Information
| Provider Information | |||||||||
| NPI: | 1922434059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSH | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | COLLIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 ZANTE CURRANT RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277036488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369914551 | ||||||||
| FaxNumber: | 6082034544 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849745415 | ||||||||
| FaxNumber: | 9199668065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2013 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 23830 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.