Organization
JACKSON PHARMACY CORP
Active
Other names
Jackson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LAZARO MORENO (OWNER)
(786) 502-2250
Entity
Organization
Contact information
Practice address
2356 NW 7TH ST, MIAMI, FL 33125-3249
(786) 502-2250
(786) 502-2273
Mailing address
2356 NW 7TH ST, MIAMI, FL 33125-3249
(786) 502-2250
(786) 502-2273
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH26920
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141334
PK
—
Enumeration date
08/19/2013
Last updated
04/10/2014
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