MEDICARE: JACKSON DRUGS, LLC

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	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821754037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON DRUGS, LLC

Provider Business Mailing Address
First Line	:	2301 OKEECHOBEE RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-6597
Country	:	US
Telephone Number	:	772-464-3784
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 OKEECHOBEE RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-6597
Country	:	US
Telephone Number	:	772-464-3784
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHARMACY MANAGER
Name	:	AKASH L RAMLAGAN
Credential	:	RPH
Telephone Number	:	772-464-3784

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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