Organization
JACKSONS DISCOUNT PHARMACY INC
Active
Other names
JACKSONS DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GARY JACKSON RPH (PRESIDENT)
(228) 832-8000
Entity
Organization
Contact information
Practice address
11340 THREE RIVERS RD, STE A, GULFPORT, MS 39503-3660
(228) 832-8000
(228) 832-0808
Mailing address
11340 THREE RIVERS RD, STE A, GULFPORT, MS 39503-3660
(228) 832-8000
(228) 832-0808
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
02264/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030343
—
MS
01
—
2045339
PK
—
Enumeration date
06/22/2006
Last updated
07/19/2018
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