Provider Demographics
NPI:1568909893
Name:JACKSON, ROBIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
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:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:MS
Mailing Address - Zip Code:38879-1671
Mailing Address - Country:US
Mailing Address - Phone:662-810-7732
Mailing Address - Fax:662-810-7738
Practice Address - Street 1:5060 RAYMOND AVENUE
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3880
Practice Address - Country:US
Practice Address - Phone:662-810-7732
Practice Address - Fax:662-810-7738
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-099821835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care