Individual
DR. LAURA ASHLYN BROOME JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(704) 996-3058
Mailing address
209 BENNETTS GROVE LN, SUFFOLK, VA 23435-3791
(704) 996-3058
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0013225
CT
183500000X
Pharmacist
Primary
21072
NC
183500000X
Pharmacist
36149
TN
Other
Enumeration date
06/22/2017
Last updated
10/12/2017
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