Healthcare Provider Details

I. General information

NPI: 1043213515
Provider Name (Legal Business Name): RASHEEN JACKSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 6TH AVE S
BIRMINGHAM AL
35233-1601
US

IV. Provider business mailing address

2324 BELLEVUE CT
HOOVER AL
35226-6245
US

V. Phone/Fax

Practice location:
  • Phone: 205-918-2359
  • Fax: 205-930-3648
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-15965
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16058
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: