Provider Demographics
NPI:1124161435
Name:JACKSON DRUGS, LLC
Entity type:Organization
Organization Name:JACKSON DRUGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMLAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:772-464-3784
Mailing Address - Street 1:2301 OKEECHOBEE RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-6554
Mailing Address - Country:US
Mailing Address - Phone:772-464-3784
Mailing Address - Fax:772-467-9153
Practice Address - Street 1:2301 OKEECHOBEE RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-6554
Practice Address - Country:US
Practice Address - Phone:772-464-3784
Practice Address - Fax:772-467-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH65773336C0003X
261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1032250OtherPHARMACY
FL110883600Medicaid
FL103687400Medicaid