Provider Demographics
NPI:1407140742
Name:JACKSON, BARBARA (BS, PHARMD, CP)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BS, PHARMD, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 HEASLEY RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-6233
Mailing Address - Country:US
Mailing Address - Phone:941-460-0883
Mailing Address - Fax:
Practice Address - Street 1:2206 HEASLEY RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-6233
Practice Address - Country:US
Practice Address - Phone:941-460-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21314183500000X
FLPS48229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist