Charles Wayne Jackson Jr., PHARMACIST

Primary specialty

PharmacistTaxonomy code 183500000X

License

16860 Issued in NE

Practice address

2451 N 90TH St
Omaha, NE 68134-6009

Phone

(402) 609-5275

NPI assigned

Aug 7, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Walmart Inc.

  • Community/Retail Pharmacy
  • Omaha, NE
  • NPI 1376977090
  NPD

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596758400000",
    "number": "1134739733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 N 90TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681346009",
            "telephone_number": "402-609-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 N 90TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681346009",
            "telephone_number": "402-609-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHARLES",
        "middle_name": "WAYNE",
        "name_suffix": "Jr.",
        "credential": "PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-07",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NE",
            "license": "16860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett Randall Jackson, D.P.T., A.T.C.
• Brittney Jackson
• Caila Jackson
• Carlotta Jackson
• Catrice Marie Jackson, LMHP,LPC
• Charnia Jackson
• Christine Nicole Jackson, MS, CF-SLP
• Ciara R Jackson
• Corey Jackson
• Courtney Jackson

• Pharmacist in Omaha, NE
• Providers in Omaha, NE by specialty
• Pharmacist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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.