MEDICARE: ABIGAIL JACKSON PHARMD

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	183500000X	Pharmacist	I068742	NY

General Provider Information

NPI Number	:	1134872294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL JACKSON PHARMD

Provider Business Mailing Address
First Line	:	80 BROADWAY APT A
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1960
Country	:	US
Telephone Number	:	518-338-7230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2160 STATE ROUTE 9
Second Line	:
City	:	LAKE GEORGE
State	:	NY
Zip	:	12845-6120
Country	:	US
Telephone Number	:	518-668-0043
Fax Number	:	518-668-0051

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

Provider Enumeration Date	:	01/30/2022
Last Update Date	:	12/03/2025

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