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NPI Code Detail

MEDICARE: JADE INDIRA JACKSON

MEDICARE: JADE INDIRA 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
1183500000XPharmacistPS58372FL

General Provider Information

NPI Number : 1902371800
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE INDIRA JACKSON
Provider Business Mailing Address
First Line : 301 S STATE ROAD 7
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33023-6756
Country : US
Telephone Number : 754-260-6711
Fax Number :
Provider Business Practice Location Address
First Line : 301 S STATE ROAD 7
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33023-6756
Country : US
Telephone Number : 754-260-6711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2018
Last Update Date : 10/06/2018

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Directions to “ JADE INDIRA JACKSON ” Practice Location

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