MEDICARE: JOSHUA JACKSON PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	03326925	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000000	OTHER		N/A

General Provider Information

NPI Number	:	1033833447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA JACKSON PHARM.D.

Provider Business Mailing Address
First Line	:	2170 CHELTENHAM RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-4345
Country	:	US
Telephone Number	:	614-314-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	2170 CHELTENHAM RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-4345
Country	:	US
Telephone Number	:	614-314-6350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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