1265728687 NPI number — DR. DELILAH JERELYN JACKSON PHARM.D.

Table of content: DR. DELILAH JERELYN JACKSON PHARM.D. (NPI 1265728687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265728687 NPI number — DR. DELILAH JERELYN JACKSON PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
DELILAH
Provider Middle Name:
JERELYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265728687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CAMPUS BOX 3087
Provider Second Line Business Mailing Address:
WINGATE UNIVERSITY- SCHOOL OF PHARMACY
Provider Business Mailing Address City Name:
WINGATE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28174-0159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-233-8647
Provider Business Mailing Address Fax Number:
704-233-8332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
559 JACKSON PARK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANNAPOLIS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-932-1155
Provider Business Practice Location Address Fax Number:
704-233-8332
Provider Enumeration Date:
06/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  19689 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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