Individual
DR. RICKY ADONIS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
510 KINGS HWY, SHREVEPORT, LA 71104-4444
(318) 424-0896
Mailing address
510 KINGS HWY, SHREVEPORT, LA 71104-4444
(318) 424-0896
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
021137
LA
Other
Enumeration date
07/28/2015
Last updated
07/28/2015
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