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Organization
JACKSONS DISCOUNT PHARMACY INC
Active
Organization
JACKSONS DISCOUNT PHARMACY INC
Active
Other names
JACKSONS DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GARY JACKSON RPH (PRESIDENT)
(228) 832-8000
Entity
Organization
Contact information
Practice address
11340 THREE RIVERS RD, STE A, GULFPORT, MS 39503-3660
(228) 832-8000
(228) 832-0808
Mailing address
11340 THREE RIVERS RD, STE A, GULFPORT, MS 39503-3660
(228) 832-8000
(228) 832-0808
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
02264/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030343
—
MS
01
—
2045339
PK
—
Enumeration date
06/22/2006
Last updated
07/19/2018
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