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NPI Code Detail

MEDICARE: DARCY JACKSON

MEDICARE: DARCY JACKSON
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
1183500000XPharmacist03131977OH

General Provider Information

NPI Number : 1568063048
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARCY JACKSON
Provider Business Mailing Address
First Line : 619 COUNTRY CLUB LN
Second Line :
City : ASHLAND
State : OH
Zip : 44805-4238
Country : US
Telephone Number : 216-402-2683
Fax Number :
Provider Business Practice Location Address
First Line : 2485 POSSUM RUN RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44903-9447
Country : US
Telephone Number : 419-756-7177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2020
Last Update Date : 11/03/2020

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