Individual
DR. LA'DAIJA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
170 LEONTYNE PRICE BLVD, LAUREL, MS 39440-4428
(601) 428-5977
Mailing address
6 POND DR, PETAL, MS 39465-4283
(601) 325-6615
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-100949
MS
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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