| NPI | 1558028670 |
|---|---|
| Other Name | JACKSON PHARMACY |
| Entity Type | Organization |
| Authorized Contact | SHANTELLE LEATHERWOOD CEO 901-260-8541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2022-12-14 |