Healthcare Provider Details

I. General information

NPI: 1124161435
Provider Name (Legal Business Name): JACKSON DRUGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 OKEECHOBEE RD
FORT PIERCE FL
34950-6554
US

IV. Provider business mailing address

2301 OKEECHOBEE RD
FORT PIERCE FL
34950-6554
US

V. Phone/Fax

Practice location:
  • Phone: 772-464-3784
  • Fax: 772-467-9153
Mailing address:
  • Phone: 772-464-3784
  • Fax: 772-467-9153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH6577
License Number StateFL

VIII. Authorized Official

Name: MR. AKASH RAMLAGAN
Title or Position: OWNER
Credential: RPH
Phone: 772-464-3784