Healthcare Provider Details

I. General information

NPI: 1093309965
Provider Name (Legal Business Name): JACKSON WOOD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 HILLSBORO RD
FRANKLIN TN
37064
US

IV. Provider business mailing address

4401 WADSWORTH BLVD
WHEAT RIDGE CO
80033-3302
US

V. Phone/Fax

Practice location:
  • Phone: 615-595-8185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0023369
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: