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General NPI Number Information
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NPI Number | 1851171730
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Entity Type | Individual
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Provider Name | RICHARD JACKSON PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 338 MONTGOMERY AVE
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City | MERION STATION
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State | PA
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Zip | 19066-1202
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Country | US
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Telephone | 610-664-4815
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Fax | 610-664-5854
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Provider Business Mailing Address
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Address Line | 338 MONTGOMERY AVE
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City | MERION STATION
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State | PA
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Zip | 19066-1202
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Country | US
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Telephone | 610-574-9186
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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 | RP041566L
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License Number State | PA
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