Active NPI
Mark Kent Jackson
- Pharmacist
- Athens, AL
National Provider Identifier
1063620516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11878
- Practice address
- 605 Hwy 31 South
Suite D
Athens, AL 35611 - Phone
- (256) 232-8274
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11878 | AL | Primary |
Addresses
Primary practice location
605 Hwy 31 South
Suite D
Athens, AL 35611
Mailing address
18765 Cypress Pointe Drive
Athens, AL 35613
Phone (256) 230-0673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11878 | AL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Salem Pharmacy | Current | Accepting new patients | |
| Athens Creekside Drugs, LLC | Pharmacist | Current | Accepting new patients |
Locations
605 US Highway 31 S
Ste D
Athens, AL 35611
Phone (256) 232-8274
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacist
- Athens, AL
- NPI 1144339995
-
- Community/Retail Pharmacy
- Elkmont, AL
- NPI 1548787898
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063620516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18765 CYPRESS POINTE DRIVE",
"city": "ATHENS",
"state": "AL",
"postal_code": "35613",
"telephone_number": "256-230-0673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 HWY 31 SOUTH",
"address_2": "SUITE D",
"city": "ATHENS",
"state": "AL",
"postal_code": "35611",
"telephone_number": "256-232-8274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARK",
"middle_name": "KENT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "11878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.