MEDICARE: JACKSON WRIGHT

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	33498	NC

General Provider Information

NPI Number	:	1497578140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON WRIGHT

Provider Business Mailing Address
First Line	:	715 W TRADE ST
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-1544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 W TRADE ST
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-1544
Country	:	US
Telephone Number	:	704-922-7187
Fax Number	:

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

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/01/2024

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Directions to “ JACKSON WRIGHT ” Practice Location

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