| Doctor Name: | MR. IGDALIAH JACKSON |
| NPI Number: | 1700210184 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARM D |
| License Number: | RPI006951 |
| Business Practice Address: | 1207b Chester Pike Eddystone, PA - 190221332 |
| Business Phone Number: | 6103330131 |
| Business Fax Number: | |
| Mailing Address: | 1207b Chester Pike, EDDYSTONE |
| State: | PA |
| Postal Code: | 190221332 |
| Phone Number: | 6103330131 |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2013 |
| NPI Last Update Date: | 08/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P0018X |
| License Number: | RPI006951 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |