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NPI Code Detail

MEDICARE: ANDREW JACKSON PHARM.D.

MEDICARE: ANDREW 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
1183500000XPharmacist03233746OH

General Provider Information

NPI Number : 1447850227
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW JACKSON PHARM.D.
Provider Business Mailing Address
First Line : 3776 FAIRWAY PARK DR APT 212
Second Line :
City : COPLEY
State : OH
Zip : 44321-2986
Country : US
Telephone Number : 330-696-7950
Fax Number :
Provider Business Practice Location Address
First Line : 3520 HUDSON DR
Second Line :
City : STOW
State : OH
Zip : 44224-2907
Country : US
Telephone Number : 330-923-8338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2020
Last Update Date : 10/29/2020

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Directions to “ ANDREW JACKSON PHARM.D.” Practice Location

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