Provider Demographics
NPI:1003998105
Name:JACKSON, ARCHIBALD J II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ARCHIBALD
Middle Name:J
Last Name:JACKSON
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26492 CLYDESDALE LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO BELAGO
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3331
Mailing Address - Country:US
Mailing Address - Phone:714-926-2292
Mailing Address - Fax:
Practice Address - Street 1:26492 CLYDESDALE LN
Practice Address - Street 2:
Practice Address - City:RANCHO BELAGO
Practice Address - State:CA
Practice Address - Zip Code:92555-3331
Practice Address - Country:US
Practice Address - Phone:714-926-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171471835P1200X, 1835P0018X, 183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support