Individual
MR. NICK JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
N3108 SCHACHT RD., PESHTIGO, WI 54157
(715) 582-2171
(920) 834-9801
Mailing address
N3108 SCHACHT RD, PESHTIGO, WI 54157-9606
(715) 582-2171
(920) 834-9801
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1085340
WI
183500000X
Pharmacist
5302021431
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982922860
—
WI
Enumeration date
10/18/2012
Last updated
10/18/2012
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