Provider Demographics
NPI:1891066858
Name:JACKSON, ANNE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
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 1:1260 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1732
Mailing Address - Country:US
Mailing Address - Phone:402-533-8444
Mailing Address - Fax:402-533-8480
Practice Address - Street 1:1260 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1732
Practice Address - Country:US
Practice Address - Phone:402-533-8444
Practice Address - Fax:402-533-8480
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20566183500000X
NE12707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist