Healthcare Provider Details

I. General information

NPI: 1891608725
Provider Name (Legal Business Name): JACKSON MACADE BRANCH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55630 HIGHWAY 424
FRANKLINTON LA
70438-7734
US

IV. Provider business mailing address

55630 HIGHWAY 424
FRANKLINTON LA
70438-7734
US

V. Phone/Fax

Practice location:
  • Phone: 985-335-4817
  • Fax:
Mailing address:
  • Phone: 985-335-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026432
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: