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General NPI Number Information
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NPI Number | 1124173190
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Entity Type | Organization
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Legal Business Name | JACKSON DISCOUNT DRUG INC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 1974 CHEROKEE RD
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City | ALEXANDER CITY
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State | AL
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Zip | 35010-3437
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Country | US
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Telephone | 256-234-2578
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Fax | 256-234-0042
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Provider Business Mailing Address
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Address Line | 1974 CHEROKEE RD
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City | ALEXANDER CITY
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State | AL
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Zip | 35010-3437
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Country | US
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Telephone | 256-234-2578
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Fax | 256-234-0042
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | BRAD F JACKSON
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Credential |
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Telephone | 256-234-2538
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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 | 6844
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 105545
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License Number State | AL
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