Individual
MATTHEW JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PD
Contact information
Practice address
301 E LAKE ST # 332, MANILA, AR 72442-9196
(870) 623-2280
Mailing address
301 E LAKE ST # 332, MANILA, AR 72442-9196
(870) 623-2280
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD08340
AR
Other
Enumeration date
04/26/2024
Last updated
04/26/2024
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