Individual
EBONY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
145 EMANUEL FARM RD LOT 77, BRUNSWICK, GA 31525-2469
(912) 571-2850
Mailing address
145 EMANUEL FARM RD LOT 77, BRUNSWICK, GA 31525-2469
(912) 571-2850
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
PHTC018695
GA
Other
Enumeration date
09/27/2019
Last updated
09/27/2019
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