Provider Demographics
NPI:1427185271
Name:JACKSON, VICTORIA LEE (PHARMD RESIDENT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHARMD RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VISTA LAKE DR
Mailing Address - Street 2:APT # 204
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-5106
Mailing Address - Country:US
Mailing Address - Phone:828-258-0670
Mailing Address - Fax:828-257-4729
Practice Address - Street 1:118 WT WEAVER BLVD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3415
Practice Address - Country:US
Practice Address - Phone:828-258-0670
Practice Address - Fax:828-257-4729
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program