Individual
DR. BRIAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5215 MEMORIAL BLVD STE 20, KINGSPORT, TN 37664-4476
(423) 279-7430
Mailing address
5215 MEMORIAL BLVD STE 20, KINGSPORT, TN 37664-4476
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
36659
TN
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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