Provider Demographics
NPI:1992812747
Name:JACKSON FAMILY PHARMACY,LLC
Entity type:Organization
Organization Name:JACKSON FAMILY PHARMACY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:PATTON
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-246-1970
Mailing Address - Street 1:1201 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-2406
Mailing Address - Country:US
Mailing Address - Phone:251-246-1970
Mailing Address - Fax:251-246-1963
Practice Address - Street 1:1201 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2406
Practice Address - Country:US
Practice Address - Phone:251-246-1970
Practice Address - Fax:251-246-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4483200003Medicare ID - Type Unspecified