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General NPI Number Information
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NPI Number | 1427623586
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Entity Type | Individual
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Provider Name | AUSTIN ZEKE JACKSON PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 605 HIGHWAY 31 SOUTH SUITE D
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City | ATHENS
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State | AL
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Zip | 35611
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Country | US
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Telephone | 256-232-8274
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Fax | 256-232-2029
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Provider Business Mailing Address
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Address Line | 22093 NICK DAVIS RD
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City | ATHENS
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State | AL
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Zip | 35613-5801
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Country | US
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Telephone | 256-431-8925
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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 | 21675
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License Number State | AL
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