Provider Demographics
NPI:1265728687
Name:JACKSON, DELILAH JERELYN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DELILAH
Middle Name:JERELYN
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:CAMPUS BOX 3087
Mailing Address - Street 2:WINGATE UNIVERSITY- SCHOOL OF PHARMACY
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174-0159
Mailing Address - Country:US
Mailing Address - Phone:704-233-8647
Mailing Address - Fax:704-233-8332
Practice Address - Street 1:559 JACKSON PARK ROAD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083
Practice Address - Country:US
Practice Address - Phone:704-932-1155
Practice Address - Fax:704-233-8332
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC196891835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist