Individual
MARK KENT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
605 HWY 31 SOUTH, SUITE D, ATHENS, AL 35611
(256) 232-8274
Mailing address
18765 CYPRESS POINTE DRIVE, ATHENS, AL 35613
(256) 230-0673
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11878
AL
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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