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General NPI Number Information
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NPI Number | 1417301136
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Entity Type | Organization
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Legal Business Name | JACKSON HOSPITAL AND CLINICS
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 1725 PINE ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-1109
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Country | US
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Telephone | 334-293-8780
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Fax | 334-293-8791
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Provider Business Mailing Address
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Address Line | 1725 PINE ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-1109
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Country | US
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Telephone | 334-293-8780
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Fax | 334-293-8791
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | THOMAS HUDSON COBB
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Credential | PHARM.D.
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Telephone | 334-293-8780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 140004
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License Number State | AL
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