Individual
MONIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
6730 BLUFFTON RD, FORT WAYNE, IN 46809-2649
(260) 747-7563
Mailing address
6730 BLUFFTON RD, FORT WAYNE, IN 46809-2649
(260) 747-7563
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26023015A
IN
Other
Enumeration date
10/12/2011
Last updated
07/20/2012
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