Individual
KELECHI IHUOMA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4828 NELSON RD, LAKE CHARLES, LA 70605-5214
(773) 931-1930
Mailing address
5200 NELSON RD APT 901, LAKE CHARLES, LA 70605-0814
(773) 931-1930
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
019657
LA
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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