Individual
NICHOLAS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
941 CHEROKEE DR STE 1, MARSHALL, MO 65340-3646
(660) 886-5558
Mailing address
941 CHEROKEE DR STE 1, MARSHALL, MO 65340-3646
(660) 886-5558
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2014041857
MO
Other
Enumeration date
12/15/2014
Last updated
12/15/2014
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