Individual
DE LORENCO L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8089 STADIUM DR STE B, KALAMAZOO, MI 49009-6270
(616) 681-3828
(269) 869-5905
Mailing address
8089 STADIUM DR STE B, KALAMAZOO, MI 49009-6270
(616) 681-3828
(269) 869-5905
Taxonomy
Speciality
Code
Description
License number
State
1835I0206X
Infectious Diseases Pharmacist
Primary
5306008385
MI
Other
Enumeration date
04/28/2026
Last updated
04/28/2026
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