Provider Demographics
NPI:1184927428
Name:JACKSON, CYNTHIA HESS (RPH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:HESS
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:801 PURCELL RD
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-0081
Mailing Address - Country:US
Mailing Address - Phone:276-608-8822
Mailing Address - Fax:
Practice Address - Street 1:31 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3246
Practice Address - Country:US
Practice Address - Phone:276-642-0035
Practice Address - Fax:276-642-0036
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006383183500000X
NC18029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist