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NPI Code Detail

MEDICARE: KAILA NICHELLE JACKSON

MEDICARE: KAILA NICHELLE 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
1183500000XPharmacist24827LA

General Provider Information

NPI Number : 1801764725
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAILA NICHELLE JACKSON
Provider Business Mailing Address
First Line : 6142 MARVIN ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-0646
Country : US
Telephone Number : 773-580-4541
Fax Number :
Provider Business Practice Location Address
First Line : 8491 FARM RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89131-8241
Country : US
Telephone Number : 702-396-1713
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2025
Last Update Date : 10/23/2025

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Directions to “ KAILA NICHELLE JACKSON ” Practice Location

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