Provider Demographics
NPI:1124327044
Name:JACKSON-PATTON, LAKEISHA J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAKEISHA
Middle Name:J
Last Name:JACKSON-PATTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10277 ENGLISH MANOR DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3686
Mailing Address - Country:US
Mailing Address - Phone:504-258-3478
Mailing Address - Fax:
Practice Address - Street 1:11279 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3396
Practice Address - Country:US
Practice Address - Phone:228-832-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS010313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist