Individual
LACEY JEAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
4220 WHEATON WAY, BREMERTON, WA 98310-3604
(360) 479-3450
Mailing address
2470 PARKWOOD DR SE, PORT ORCHARD, WA 98366-2835
(360) 769-8355
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH60213399
WA
Other
Enumeration date
05/12/2011
Last updated
05/12/2011
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