Individual
EDWARD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11214 JEFFERSON AVE, NEWPORT NEWS, VA 23601-2207
(757) 327-7478
Mailing address
11214 JEFFERSON AVE, NEWPORT NEWS, VA 23601-2207
(757) 327-7478
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
0230034593
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0230034593
PHARMACY TECHNICIAN LICENSE
VA
Enumeration date
03/29/2021
Last updated
03/29/2021
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