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NPI Code Detail

MEDICARE: DR. MARY ELIZABETH JACKSON PHARM.D.

MEDICARE:  DR. MARY ELIZABETH 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
1183500000XPharmacist13642CO
2183500000XPharmacist044942MO

General Provider Information

NPI Number : 1528016003
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY ELIZABETH JACKSON PHARM.D.
Provider Business Mailing Address
First Line : PO BOX 495
Second Line :
City : INDIAN HILLS
State : CO
Zip : 80454-0495
Country : US
Telephone Number : 303-885-4333
Fax Number :
Provider Business Practice Location Address
First Line : 8405 W ALAMEDA AVE
Second Line :
City : LAKEWOOD
State : CO
Zip : 80226-2908
Country : US
Telephone Number : 720-974-4977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MARY ELIZABETH JACKSON PHARM.D.” Practice Location

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