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ELLEN GILBERT JACKSON RPH
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1710013099
Individual Registrant: ELLEN GILBERT JACKSON RPH
Gender: F
Not Sole Proprietor
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: --
Tel: 706-638-3114 Fax: --
Contact information for business:
480 N RIDGE DR LA FAYETTE, GA 30728-4737 US
Tel: 706-638-2981 Fax: --
Tel: 706-638-2981 Fax: --
Registration Information:
NPI: 1710013099
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | GA | 16389 |
| N | 183500000X | Pharmacy Service Providers Pharmacist | AL | 9672 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
