Provider Demographics
NPI:1215655691
Name:JACKSON, ASHLEY H (PHARMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:H
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 1:249 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:ROOPVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30170-2037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 OAK ST
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:GA
Practice Address - Zip Code:30108-1412
Practice Address - Country:US
Practice Address - Phone:770-258-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist