Provider Demographics
NPI:1487900544
Name:JACKSON, BRITTAIN COLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRITTAIN
Middle Name:COLE
Last Name:JACKSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 JESSE MURRELL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-8229
Mailing Address - Country:US
Mailing Address - Phone:270-250-9800
Mailing Address - Fax:
Practice Address - Street 1:117 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748
Practice Address - Country:US
Practice Address - Phone:270-358-2117
Practice Address - Fax:270-358-2100
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist