Provider Demographics
NPI:1104057686
Name:JACKSON, TERRI WHITLEY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:WHITLEY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:TERRI
Other - Middle Name:LYNETTE
Other - Last Name:WHITLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3671 JOOR RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-3104
Mailing Address - Country:US
Mailing Address - Phone:225-924-3880
Mailing Address - Fax:225-924-9753
Practice Address - Street 1:3671 JOOR RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-3104
Practice Address - Country:US
Practice Address - Phone:225-924-3880
Practice Address - Fax:225-924-9753
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist