Individual
DANIEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH.
Contact information
Practice address
6839 S WESTNEDGE AVE, T-0604, PORTAGE, MI 49002-3582
(269) 327-9646
(269) 327-9646
Mailing address
6839 S WESTNEDGE AVE, T-0604, PORTAGE, MI 49002-3582
(269) 327-9646
(269) 327-9646
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302027655
MI
Other
Enumeration date
11/10/2011
Last updated
11/10/2011
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