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General NPI Number Information
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NPI Number | 1568064491
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Entity Type | Organization
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Legal Business Name | JACKSON APOTHECARY, LLC
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 12755 HWY 22E
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City | NEW SITE
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State | AL
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Zip | 36256-3625
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Country | US
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Telephone | 205-422-8114
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Fax |
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Provider Business Mailing Address
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Address Line | 3633 ALTADENA DR
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City | VESTAVIA
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State | AL
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Zip | 35243-2229
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Country | US
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Telephone | 205-422-8114
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BRAD JACKSON
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Credential | PHARM D
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Telephone | 205-422-8114
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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 |
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License Number State |
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