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General NPI Number Information
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NPI Number | 1043595622
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Entity Type | Individual
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Provider Name | CHERYL ANN JACKSON RPH
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Gender | Female
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 1410 N BLUFF ST
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City | FULTON
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State | MO
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Zip | 65251-2350
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Country | US
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Telephone | 573-592-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 215 LEE ST
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City | FULTON
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State | MO
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Zip | 65251-1424
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Country | US
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Telephone | 573-544-6162
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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 | 044607
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 31901
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License Number State | TX
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