MEDICARE: DR. BRAD F JACKSON PHARM D

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	183500000X	Pharmacist	13691	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13691	OTHER	AL	STATE PHARMACY LICENSE

General Provider Information

NPI Number	:	1972508729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD F JACKSON PHARM D

Provider Business Mailing Address
First Line	:	1953 CAHABA CREST DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-4412
Country	:	US
Telephone Number	:	205-437-0867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3346 MORGAN DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216-3052
Country	:	US
Telephone Number	:	205-822-5200
Fax Number	:	205-979-3666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. BRAD F JACKSON PHARM D” Practice Location

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