Individual ProviderJordan VermillionPharmacistPharmacy Service ProvidersPractice Address12201 Academy Rd NE, Albuquerque, NM 87111-8051(505) 275-9733PECOS EnrollmentBased on the most recent information from CMS, provider Jordan Vermillion does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1902453541Provider TypeIndividualFull NameVermillion, JordanGenderMaleSole ProprietorYesEnumeration Date8/19/2019Last Updated8/19/2019Contact InformationPractice LocationPractice Address12201 Academy Rd NE, Albuquerque, NM 87111-8051Phone(505) 275-9733FaxUnlisted FaxMailing LocationMailing Address12201 Academy Rd NE, Albuquerque, NM 87111-8051Phone(505) 275-9733FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicenseRP00009169New Mexico