Individual
RAVEN S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1111 MEDICAL CENTER BLVD, S 850, MARRERO, LA 70072-3151
(504) 349-6450
(504) 349-6454
Mailing address
1111 MEDICAL CENTER BLVD, S 850, MARRERO, LA 70072-3151
(504) 349-6450
(504) 349-6454
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
26025677A
IN
183500000X
Pharmacist
Primary
PST.021789
LA
Other
Enumeration date
08/24/2014
Last updated
11/21/2016
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