Provider Demographics
NPI:1609125566
Name:JACKSON, BRITANY KEYON (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRITANY
Middle Name:KEYON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 LINDA ANN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359
Mailing Address - Country:US
Mailing Address - Phone:985-665-7818
Mailing Address - Fax:
Practice Address - Street 1:309 LINDA ANN AVE
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-3316
Practice Address - Country:US
Practice Address - Phone:985-665-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist