MEDICARE: JACKSONS & J. K. PHARMACY L.L.C

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
1	3336C0003X	Community/Retail Pharmacy	27279	TX

General Provider Information

NPI Number	:	1407151699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONS & J. K. PHARMACY L.L.C

Provider Business Mailing Address
First Line	:	7909 HILLCROFT AVE
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77081
Country	:	US
Telephone Number	:	713-271-0441
Fax Number	:	713-271-0472

Provider Business Practice Location Address
First Line	:	7909 HILLCROFT ST
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77081-7202
Country	:	US
Telephone Number	:	713-271-0441
Fax Number	:	713-271-0472

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. KAEITA RANKIN-COLE
Credential	:
Telephone Number	:	713-271-0441

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	01/19/2011

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