Michael W. Jackson, a Sole Proprietor
NPI #1538278478 in San Augustine, Texas
Provider Information
- NPI Number
- 1538278478
- Entity Type
- Organization
- Organization Name
- Michael W. Jackson, a Sole Proprietor
- Primary Specialty
- Pharmacy - Community/Retail Pharmacy
- Enumeration Date
- Aug 30, 2006
- Last Updated
- Jun 12, 2015
Practice Location
- Address
- 104 E COLUMBIA ST
- City
- San Augustine
- State
- Texas
- ZIP Code
- 75972-1902
- Phone
- (936) 275-3401
Authorized Official
- Name
- MICHAEL W JACKSON
- Title
- OWNER
- Phone
- (936) 275-3401
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy |
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