Provider Demographics
NPI:1497171599
Name:JACKSON, JEFF (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:JACKSON
Suffix:
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 1:2013 LANTERN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-6010
Mailing Address - Country:US
Mailing Address - Phone:859-575-5033
Mailing Address - Fax:859-575-5065
Practice Address - Street 1:2013 LANTERN RIDGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-6010
Practice Address - Country:US
Practice Address - Phone:859-575-5033
Practice Address - Fax:859-575-5065
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist