Individual
TYLYN D'JERA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
17631 VILLA TRACE AVE, GREENWELL SPRINGS, LA 70739-4648
(225) 610-3790
Mailing address
17631 VILLA TRACE AVE, GREENWELL SPRINGS, LA 70739-4648
(225) 610-3790
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.021644
LA
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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