Active NPI
Royce Eugene Jackson, RPH
- Geriatric Pharmacist
- Tyler, TX
National Provider Identifier
1104794908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- 17513
- Practice address
- Stephenson Pharmacy
1000 S. Fleishel
Tyler, TX 75701 - Phone
- (903) 593-0236
- Fax
- (903) 593-9375
- NPI assigned
- Oct 24, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Geriatric Pharmacist | 1835G0303X | 17513 | TX | Primary |
Addresses
Primary practice location
Stephenson Pharmacy
1000 S. Fleishel
Tyler, TX 75701
Mailing address
701 W. Riek Road
Tyler, TX 75703
Phone (903) 539-2413
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17513 | TX | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761264000000",
"number": "1104794908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 W. RIEK ROAD",
"city": "TYLER",
"state": "TX",
"postal_code": "75703",
"telephone_number": "903-539-2413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "STEPHENSON PHARMACY",
"address_2": "1000 S. FLEISHEL",
"city": "TYLER",
"state": "TX",
"postal_code": "75701",
"telephone_number": "903-593-0236",
"fax_number": "903-593-9375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ROYCE",
"middle_name": "EUGENE",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-10-24",
"last_updated": "2025-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "TX",
"license": "17513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.