Healthcare Provider Details

I. General information

NPI: 1013292101
Provider Name (Legal Business Name): REBECCA CAROL JACKSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S CARAWAY RD
JONESBORO AR
72401-4507
US

IV. Provider business mailing address

2301 AUBURN DALE CV
JONESBORO AR
72404-9491
US

V. Phone/Fax

Practice location:
  • Phone: 870-268-1442
  • Fax:
Mailing address:
  • Phone: 870-932-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10328
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: