Alyssa Simone Jackson
Pharmacy Technician in Ferguson, MO. Individual provider (NPI-1).
NPI number1295506186
StatusActive
Last updated in NPPESJan 10, 2024
Details
- NPI
- 1295506186
- Entity type
- Individual (NPI-1)
- Name
- Alyssa Simone Jackson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 10, 2024
- Certification date
- Jan 10, 2024
- Last updated
- Jan 10, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 183700000X | Pharmacy Technician | 2021004266 | MO | Yes |
Practice location
190 N Florissant RdFerguson, MO 63135-1942
Phone 314-521-4518
Mailing address
190 N Florissant RdFerguson, MO 63135-1942
Phone 314-521-4518
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