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ELLEN GILBERT JACKSON RPH

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1710013099

Individual Registrant:
 ELLEN GILBERT JACKSON RPH
Gender: F
Not Sole Proprietor

Location and contact information for practice:
324 PATTON STREET MEDITHRIFT PHARMACY LA FAYETTE, GA 30728 US
Tel: 706-638-3114  Fax: --

Contact information for business:
480 N RIDGE DR  LA FAYETTE, GA 30728-4737 US
Tel: 706-638-2981  Fax: --

Registration Information:
NPI: 1710013099
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
GA16389
N183500000XPharmacy Service Providers
Pharmacist
AL9672

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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