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General NPI Number Information
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NPI Number | 1568669208
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Entity Type | Organization
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Legal Business Name | JACKSON'S DISCOUNT PHARMACY, INC.
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 11340 THREE RIVERS RD STE A
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City | GULFPORT
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State | MS
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Zip | 39503-3650
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Country | US
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Telephone | 228-832-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 11340 THREE RIVERS RD STE A
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City | GULFPORT
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State | MS
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Zip | 39503-3650
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Country | US
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Telephone | 228-832-0808
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. LINDA MARIE JACKSON
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Credential |
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Telephone | 228-832-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 02264011
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License Number State | MS
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