| NPI | 1437871100 |
|---|---|
| Doing Business As | JACKSON STREET DRUG |
| Entity Type | Organization |
| Authorized Contact | BRENDAN WEBBER Gm 573-581-7561 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2022-09-19 |