MPT Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE010068 Issued in GA

Legal business name

MPT PHARMACY LLC

Doing business as

Jackson Pharmacy

Practice address

170 John Randolph Dr
Hoschton, GA 30548-1502

Phone

(706) 658-0064

Fax

(706) 654-0330

NPI assigned

Aug 7, 2014

Organization subpart

No

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

Authorized official

Name

Ross Daniel Rainey, PHARM.D.NPI 1972937431

Title

Pharmacy Manager

Phone

(706) 658-0064

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Jackson Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ross Daniel Rainey, PHARM.D.

  • Pharmacist
  • Hoschton, GA
  • NPI 1972937431
  NPD Authorized official
• Matthew Taylor Bridges, PHARM.D.

  • Pharmacist
  • Athens, GA
  • NPI 1588136386
  NPD

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

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1073922670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 JOHN RANDOLPH DR",
            "city": "HOSCHTON",
            "state": "GA",
            "postal_code": "305481502",
            "telephone_number": "706-658-0064",
            "fax_number": "706-658-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 JOHN RANDOLPH DR",
            "city": "HOSCHTON",
            "state": "GA",
            "postal_code": "305481502",
            "telephone_number": "706-658-0064",
            "fax_number": "706-654-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MPT PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-07",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A",
        "authorized_official_last_name": "RAINEY",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "706-658-0064",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010068",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003149971A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147287",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randy Lee McSkulin, DC
• Marissa Maricel Armamento Mercado, MD
• Jacqueline Miller
• Samuel Mink, PT, DPT
• Momentum for Living, LLC
• Mulberry Counseling, LLC
• Suchi Mulji, APRN, FNP-C
• Nicholas Najor, PT, DPT
• Alice Veciunca Necula, M.ED., CCC-SLP
• Duc Trung Nguyen, D.D.S

• Community/Retail Pharmacy in Hoschton, GA
• Providers in Hoschton, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.