Healthcare Provider Details

I. General information

NPI: 1821952516
Provider Name (Legal Business Name): MEGHAN JACKSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY STE 204
CORBIN KY
40701-8426
US

IV. Provider business mailing address

1 TRILLIUM WAY STE 204
CORBIN KY
40701-8426
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-1934
  • Fax: 606-526-4031
Mailing address:
  • Phone: 606-523-1934
  • Fax: 606-526-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number024379
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: