Provider Demographics
NPI:1245507813
Name:JACKSON, BEVERLY HIGH (DPH)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:HIGH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 CROWN POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-8398
Mailing Address - Country:US
Mailing Address - Phone:850-356-8344
Mailing Address - Fax:
Practice Address - Street 1:2950 S BLUE ANGEL PKWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6905
Practice Address - Country:US
Practice Address - Phone:850-454-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44559183500000X
TN5165183500000X
AL10137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist