Individual
MATTHEW KANE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
942 LOY CEMETERY RD, COLUMBIA, KY 42728-8719
(270) 250-9801
Mailing address
942 LOY CEMETERY RD, COLUMBIA, KY 42728-8719
(270) 250-9801
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
015662
KY
Other
Enumeration date
08/28/2012
Last updated
08/28/2012
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