Organization
JACKSON PHARMACY INC
Active
Other names
OAK PARK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LONNIE JACKSON PD (PRESIDENT)
(870) 698-1974
Entity
Organization
Contact information
Practice address
1305 WHITE DR, BATESVILLE, AR 72501-9467
(870) 698-1974
(870) 698-0141
Mailing address
PO BOX 2114, BATESVILLE, AR 72503-2114
(870) 698-1974
(870) 698-0141
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR13396
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114918407
—
AR
01
—
1994353
PK
—
Enumeration date
09/29/2005
Last updated
12/05/2016
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