Provider Demographics
NPI:1578851630
Name:JACKSON, JAMES A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
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 1:853 HARBOR BLVD
Mailing Address - Street 2:STORE 8201
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2709
Mailing Address - Country:US
Mailing Address - Phone:850-654-0852
Mailing Address - Fax:850-654-0852
Practice Address - Street 1:853 HARBOR BLVD
Practice Address - Street 2:STORE 8201
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2709
Practice Address - Country:US
Practice Address - Phone:850-654-0852
Practice Address - Fax:850-654-0852
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0032320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist