Provider Demographics
NPI:1558374967
Name:JACKS, WILL DAVID II (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:WILL
Middle Name:DAVID
Last Name:JACKS
Suffix:II
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-1131
Mailing Address - Country:US
Mailing Address - Phone:256-463-2197
Mailing Address - Fax:256-463-2306
Practice Address - Street 1:875 ROSS ST
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:AL
Practice Address - Zip Code:36264-1131
Practice Address - Country:US
Practice Address - Phone:256-463-2197
Practice Address - Fax:256-463-2306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist