Provider Demographics
NPI:1922230739
Name:JACKSON, RICHARD LYNN JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LYNN
Last Name:JACKSON
Suffix:JR
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 1:2243 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-9070
Mailing Address - Country:US
Mailing Address - Phone:615-799-0600
Mailing Address - Fax:615-799-9849
Practice Address - Street 1:2243 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-9070
Practice Address - Country:US
Practice Address - Phone:615-799-0600
Practice Address - Fax:615-799-9849
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist