Individual
MRS. AMY ELLIS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
620 VIRGINIA AVE N, TIFTON, GA 31794-4227
(229) 386-1171
(229) 516-1885
Mailing address
620 VIRGINIA AVE N, TIFTON, GA 31794-4227
(229) 386-1171
(229) 516-1885
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
025495
GA
Other
Enumeration date
01/12/2013
Last updated
01/12/2013
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