Individual
ELLEN GILBERT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
324 PATTON STREET, MEDITHRIFT PHARMACY, LA FAYETTE, GA 30728
(706) 638-3114
Mailing address
480 N RIDGE DR, LA FAYETTE, GA 30728-4737
(706) 638-2981
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16389
GA
183500000X
Pharmacist
9672
AL
Other
Enumeration date
02/23/2007
Last updated
07/08/2007
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