Jackson Drug Co

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

JACKSON DRUG CO

Doing business as

Jackson Drug

Practice address

506 2ND St
Jackson, MN 56143-0233

Phone

(507) 847-3161

Fax

(507) 847-2480

NPI assigned

Feb 20, 2007

Last updated

Aug 13, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lance Edlin, RPH

Title

Owner

Phone

(507) 847-3161

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• JACKSON DRUG Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186963200000",
    "number": "1053456889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 2ND ST",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561430233",
            "telephone_number": "507-847-3461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 2ND ST",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561430233",
            "telephone_number": "507-847-3161",
            "fax_number": "507-847-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DRUG CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-08-13",
        "status": "A",
        "authorized_official_last_name": "EDLIN",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-847-3161",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MN",
            "license": "22124900",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2405632",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSON DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Davis Huggins, M.D.
• Habiba Alero Ikoghode, M.D.
• Jackson Chiropractic, P.a.
• Jackson County Central Schools
• Jackson County Human Services
• Jackson Volunteer Ambulance (Jackson Ambulance Service)
• Brianna Nicole Joel, LICSW
• Martha Arlene Johnson, PAC
• Journeys of Healing, Inc
• Johanna Kallemeyn, FNP-C

• Community/Retail Pharmacy in Jackson, MN
• Providers in Jackson, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.