Individual
DR. JACKSON ALLEN KICKLIGHTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD, MHA, BCMTMS
Contact information
Practice address
20 W BANK ST STE 6, PETERSBURG, VA 23803-3279
(804) 835-5425
Mailing address
3424 MIDHURST DR, CHESTER, VA 23831-1462
(706) 871-5549
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202219611
VA
183500000X
Pharmacist
29807
NC
Other
Enumeration date
09/23/2020
Last updated
10/21/2022
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