MEDICARE: TROYELL JACKSON

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	025601	LA

General Provider Information

NPI Number	:	1518774314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROYELL JACKSON

Provider Business Mailing Address
First Line	:	10500 HAYNE BLVD APT 705
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-1385
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 MEDICAL CENTER BLVD STE N116
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3152
Country	:	US
Telephone Number	:	504-349-6185
Fax Number	:

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	08/17/2025

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Directions to “ TROYELL JACKSON ” Practice Location

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