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General NPI Number Information
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NPI Number | 1528672680
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Entity Type | Individual
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Provider Name | ERICA PAIGE JACKSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 30 BALDWIN BLVD
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City | SHAMOKIN DAM
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State | PA
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Zip | 17876-9519
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Country | US
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Telephone | 570-884-7970
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BALDWIN BLVD
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City | SHAMOKIN DAM
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State | PA
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Zip | 17876-9519
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Country | US
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Telephone | 570-884-7970
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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 | RP4544977
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RP4544977
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0134842
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License Number State | VT
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 068159
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License Number State | NY
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