Individual
SUSAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
5540 S 900 E, SALT LAKE CITY, UT 84117-7206
(801) 262-2981
Mailing address
1912 BLAINE AVE, APT B, SALT LAKE CITY, UT 84108-2908
(801) 484-4063
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5798331-1701
UT
Other
Enumeration date
09/09/2010
Last updated
09/09/2010
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