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General NPI Number Information
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NPI Number | 1528108677
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Entity Type | Organization
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Legal Business Name | JACKSONS DRUGS OF MONTICELLO, INC.
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 1308 SW GRAND ST
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City | GREENVILLE
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State | FL
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Zip | 32331
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Country | US
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Telephone | 850-948-3011
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Fax | 850-948-3778
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | GREENVILLE
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State | FL
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Zip | 32331-0129
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Country | US
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Telephone | 850-948-3011
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Fax | 850-948-3778
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Authorized Official
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Title or Position | VP
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Name | MR. CHARLES D JACKSON
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Credential | R.PH.
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Telephone | 850-948-3011
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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 | PH12505
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License Number State | FL
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