Provider Demographics
NPI:1134437791
Name:JACKSON, TERRENCE RAMSEY (PHARMD, PHD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:RAMSEY
Last Name:JACKSON
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 E SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4535
Mailing Address - Country:US
Mailing Address - Phone:520-577-1044
Mailing Address - Fax:
Practice Address - Street 1:4748 E SUNRISE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4535
Practice Address - Country:US
Practice Address - Phone:520-577-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist