NPI 1225584121

Tylyn D'Jera Jackson, PHARMD

Practitioner Pharmacist Greenwell Springs, LA

Practice location

Address: 17631 Villa Trace Ave, Greenwell Springs, LA 70739-4648
Phone: (225) 610-3790

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence PST.021644 (LA)

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Registry record

NPI: 1225584121
Entity type: Individual
Sex (as registered): Female
NPI issued: 30 Aug 2016
Record last updated: 30 Aug 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.