Provider Demographics
NPI:1538879200
Name:SINCLAIR, JORDAN BRADFORD (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BRADFORD
Last Name:SINCLAIR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5659 GREEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3996
Mailing Address - Country:US
Mailing Address - Phone:248-921-1024
Mailing Address - Fax:
Practice Address - Street 1:1819 S HASTINGS WAY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4504
Practice Address - Country:US
Practice Address - Phone:715-834-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21288-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist