Provider Demographics
NPI:1144347972
Name:JACKSON, SHIRI R (PHARMD)
Entity type:Individual
Prefix:MS
First Name:SHIRI
Middle Name:R
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 E NORTH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2283
Mailing Address - Country:US
Mailing Address - Phone:410-572-8518
Mailing Address - Fax:410-202-3373
Practice Address - Street 1:125 E NORTH POINTE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2283
Practice Address - Country:US
Practice Address - Phone:410-572-8518
Practice Address - Fax:410-202-3373
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204673183500000X
DEA1-0004057183500000X
PARP045364L183500000X
MD19998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist