Individual
KELLY DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1180 CARL D SILVER PKWY, T0772, FREDERICKSBURG, VA 22401-4913
(540) 786-7957
Mailing address
1180 CARL D SILVER PKWY, T0772, FREDERICKSBURG, VA 22401-4913
(540) 786-7957
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202211533
VA
Other
Enumeration date
04/09/2013
Last updated
04/09/2013
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