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General NPI Number Information
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NPI Number | 1992812747
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Entity Type | Organization
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Legal Business Name | JACKSON FAMILY PHARMACY,LLC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 COLLEGE AVE
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City | JACKSON
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State | AL
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Zip | 36545-2406
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Country | US
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Telephone | 251-246-1970
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Fax | 251-246-1963
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Provider Business Mailing Address
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Address Line | 1201 COLLEGE AVE
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City | JACKSON
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State | AL
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Zip | 36545-2406
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Country | US
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Telephone | 251-246-1970
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Fax | 251-246-1963
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | ANITA PATTON OVERTON
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Credential | RPH
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Telephone | 251-246-1970
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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 | 11492
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License Number State | AL
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