Healthcare Provider Details

I. General information

NPI: 1003775404
Provider Name (Legal Business Name): CLAUDIA ELAINE BANKS JACKSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 S FAIR OAKS AVE STE 200
PASADENA CA
91105-4124
US

IV. Provider business mailing address

18 DOVER PL
MANHATTAN BEACH CA
90266-7228
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-0099
  • Fax: 626-449-7388
Mailing address:
  • Phone: 626-449-0099
  • Fax: 626-449-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: