Provider Demographics
NPI:1013254887
Name:JACKSON, AMANDA MEISTER (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MEISTER
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 1:10358 RIVERSIDE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4203
Mailing Address - Country:US
Mailing Address - Phone:561-557-1645
Mailing Address - Fax:
Practice Address - Street 1:10358 RIVERSIDE DR STE 140
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4203
Practice Address - Country:US
Practice Address - Phone:561-557-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist