Individual
CODY WAYNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1193 N MAIN ST, MARION, VA 24354-4121
(276) 783-6656
(276) 783-6769
Mailing address
PO BOX 665, LEBANON, VA 24266-0665
(276) 701-2965
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202210763
VA
Other
Enumeration date
11/12/2020
Last updated
11/12/2020
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