Individual
MARYLEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3 SAINT FRANCIS DR STE 360, GREENVILLE, SC 29601-3972
(864) 232-4349
(864) 233-8103
Mailing address
PO BOX 25039, GREENVILLE, SC 29616-0039
(864) 233-4349
(864) 232-8103
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
8826
SC
363A00000X
Physician Assistant
Primary
509
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0037PA
—
SC
05
—
3337PA
—
SC
Enumeration date
06/10/2006
Last updated
04/01/2016
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