Provider Demographics
NPI:1659823771
Name:HAAS, JORDEN (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDEN
Middle Name:
Last Name:HAAS
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 1:6011 N COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-7025
Mailing Address - Country:US
Mailing Address - Phone:208-596-2952
Mailing Address - Fax:
Practice Address - Street 1:6011 N COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-7025
Practice Address - Country:US
Practice Address - Phone:208-596-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60663924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist