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NPI Code Detail

MEDICARE: MRS. TERRI WHITLEY JACKSON PHARMD

MEDICARE: MRS. TERRI WHITLEY JACKSON PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist18211LA

General Provider Information

NPI Number : 1104057686
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERRI WHITLEY JACKSON PHARMD
Provider Business Mailing Address
First Line : 3671 JOOR RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70814-3104
Country : US
Telephone Number : 225-924-3880
Fax Number : 225-924-9753
Provider Business Practice Location Address
First Line : 3671 JOOR RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70814-3104
Country : US
Telephone Number : 225-924-3880
Fax Number : 225-924-9753
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2009
Last Update Date : 10/05/2022

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