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NPI Code Detail

MEDICARE: MRS. BRIANNA JACKSON RPH

MEDICARE: MRS. BRIANNA JACKSON RPH
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
1183500000XPharmacist0202218069VA

General Provider Information

NPI Number : 1659974277
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRIANNA JACKSON RPH
Provider Business Mailing Address
First Line : 2981 S MILITARY HWY
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-5810
Country : US
Telephone Number : 757-558-9830
Fax Number :
Provider Business Practice Location Address
First Line : 2981 S MILITARY HWY
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-5810
Country : US
Telephone Number : 757-558-9830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2020
Last Update Date : 11/17/2020

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