| NAME |
JACKSON PHARMACY |
| STATE |
MISSISSIPPI |
| STREET ADDR. 1 |
1500 E WOODROW WILSON AVE |
| CITY |
JACKSON |
| ZIP |
39216-5116 |
| OFFICIAL VA NAME |
Jackson Pharmacy |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
JACKSON VAMC PHARMACY |
| EFFECTIVE DATE/TIME |
-
- 2006-08-22 00:00:00
- STATUS: ACTIVE
- NPI: 1932167756
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 1500 EAST WOODROW WILSON AVENUE
- CITY (CHANGED FROM): JACKSON
- STATE (CHANGED FROM): MISSISSIPPI
- ZIP (CHANGED FROM): 39216-5116
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1932167756
|
