Organization
JACKSON COMMUNITY PHARMACY, LLC
Active
Other names
Jackson Community Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER MERRIWETHER (MANAGING MEMBER)
(601) 983-1239
Entity
Organization
Contact information
Practice address
350 W WOODROW WILSON AVE STE 311, JACKSON, MS 39213-7681
(601) 326-5370
(601) 982-7103
Mailing address
1485 LIVINGSTON LN, JACKSON, MS 39213-8004
(601) 983-1239
(601) 982-7103
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
F14158
MS
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149725
PK
—
Enumeration date
01/20/2015
Last updated
01/20/2015
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