Organization
JEROME D. JACKSON
Active
Other names
MEDICAL CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME D JACKSON (OWNER PHARMACIST)
(907) 452-2328
Entity
Organization
Contact information
Practice address
1867 AIRPORT WAY, SUITE 105, FAIRBANKS, AK 99701-4007
(907) 452-2328
Mailing address
1867 AIRPORT WAY, SUITE 105, FAIRBANKS, AK 99701-4007
(907) 452-2328
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
312
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0200624
NABP NUMBER
AK
05
—
MSO268
—
AK
05
—
PHO268
—
AK
Enumeration date
03/26/2007
Last updated
09/06/2023
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