MEDICARE: RICHARD JACKSON PHARMACIST

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	183500000X	Pharmacist	RP041566L	PA

General Provider Information

NPI Number	:	1851171730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD JACKSON PHARMACIST

Provider Business Mailing Address
First Line	:	338 MONTGOMERY AVE
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1202
Country	:	US
Telephone Number	:	610-574-9186
Fax Number	:

Provider Business Practice Location Address
First Line	:	338 MONTGOMERY AVE
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1202
Country	:	US
Telephone Number	:	610-664-4815
Fax Number	:	610-664-5854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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