Provider Demographics
NPI:1194724187
Name:JACKSON, CINDY MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:MARIE
Last Name:JACKSON
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 1:21 CEDARIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-9295
Mailing Address - Country:US
Mailing Address - Phone:501-834-7137
Mailing Address - Fax:501-945-6976
Practice Address - Street 1:4133 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-4120
Practice Address - Country:US
Practice Address - Phone:501-945-3264
Practice Address - Fax:501-945-6976
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist