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General NPI Number Information
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NPI Number | 1134872294
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Entity Type | Individual
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Provider Name | ABIGAIL JACKSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/30/2022
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 2160 STATE ROUTE 9
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City | LAKE GEORGE
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State | NY
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Zip | 12845-6120
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Country | US
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Telephone | 518-668-0043
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Fax | 518-668-0051
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Provider Business Mailing Address
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Address Line | 80 BROADWAY APT A
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City | FORT EDWARD
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State | NY
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Zip | 12828-1960
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Country | US
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Telephone | 518-338-7230
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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 | I068742
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License Number State | NY
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