Individual
DR. MIRANDA HULETT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
711 CAMPBELL LN, BOWLING GREEN, KY 42104-1040
(270) 843-2383
(270) 783-8687
Mailing address
711 CAMPBELL LN, BOWLING GREEN, KY 42104-1040
(270) 843-2383
(270) 783-8687
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0000033743
TN
183500000X
Pharmacist
Primary
014548
KY
Other
Enumeration date
03/23/2011
Last updated
03/23/2011
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