Provider Demographics
NPI:1699869032
Name:JACKSON'S PHARMACY
Entity type:Organization
Organization Name:JACKSON'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-561-3032
Mailing Address - Street 1:PO BOX 1364
Mailing Address - Street 2:434 HWY. 18 STE. C
Mailing Address - City:MANILA
Mailing Address - State:AR
Mailing Address - Zip Code:72442
Mailing Address - Country:US
Mailing Address - Phone:870-561-3032
Mailing Address - Fax:870-561-3035
Practice Address - Street 1:434 HWY. 18
Practice Address - Street 2:STE. C
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442
Practice Address - Country:US
Practice Address - Phone:870-561-3032
Practice Address - Fax:870-561-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty