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General NPI Number Information
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NPI Number | 1013292101
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Entity Type | Individual
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Provider Name | REBECCA CAROL JACKSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 1330 S CARAWAY RD
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City | JONESBORO
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State | AR
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Zip | 72401-4507
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Country | US
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Telephone | 870-268-1442
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 AUBURN DALE CV
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City | JONESBORO
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State | AR
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Zip | 72404-9491
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Country | US
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Telephone | 870-932-4301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD10328
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License Number State | AR
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