| NPI | 1053366161 |
|---|---|
| Former Name | COURTNEY EDISON JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL 38741) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 38741) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2011-01-05 |