Provider Demographics
NPI:1063687846
Name:JACKSON, LUENETTA (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:LUENETTA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38853 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1623
Mailing Address - Country:US
Mailing Address - Phone:586-536-9449
Mailing Address - Fax:248-788-4823
Practice Address - Street 1:38853 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1623
Practice Address - Country:US
Practice Address - Phone:586-536-9449
Practice Address - Fax:248-788-4823
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020292261835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy