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NPI Code Detail

MEDICARE: DR. VINCENT EUGENE JACKSON PHARM D, RPH

MEDICARE: DR. VINCENT EUGENE JACKSON PHARM D, 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
11835P1200XPharmacotherapy Pharmacist15453MD

General Provider Information

NPI Number : 1710985783
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VINCENT EUGENE JACKSON PHARM D, RPH
Provider Business Mailing Address
First Line : 345 MADELINE DR
Second Line :
City : ST LEONARD
State : MD
Zip : 20685-2567
Country : US
Telephone Number : 301-580-3818
Fax Number : 410-535-8307
Provider Business Practice Location Address
First Line : 100 HOSPITAL RD
Second Line : PHARMACY DEPARTMENT
City : PRINCE FREDERICK
State : MD
Zip : 20678-4017
Country : US
Telephone Number : 410-535-4000
Fax Number : 410-535-8307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 03/22/2026

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