Provider Demographics
NPI:1972508729
Name:JACKSON, BRAD F (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:F
Last Name:JACKSON
Suffix:
Gender:M
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 1:1953 CAHABA CREST DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4412
Mailing Address - Country:US
Mailing Address - Phone:205-437-0867
Mailing Address - Fax:
Practice Address - Street 1:3346 MORGAN DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-3052
Practice Address - Country:US
Practice Address - Phone:205-822-5200
Practice Address - Fax:205-979-3666
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13691OtherSTATE PHARMACY LICENSE