Athens Creekside Drugs, LLC

Primary specialty

PharmacistTaxonomy code 183500000X

License

111879 Issued in AL

Legal business name

ATHENS CREEKSIDE DRUGS, LLC

Practice address

605 US Highway 31 S
Suite D
Athens, AL 35611-3645

Phone

(256) 232-8274

Fax

(256) 232-2029

NPI assigned

Aug 29, 2006

Last updated

Jan 26, 2011By 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

Mr. Mark Kent JacksonNPI 1063620516

Title

Owner/Pharmacist

Phone

(256) 232-8274

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Kent Jackson

  • Pharmacist
  • Athens, AL
  • NPI 1063620516
  NPD Authorized official
• Austin Zeke Jackson, PHARMD.

  • Pharmacist
  • Athens, AL
  • NPI 1427623586
  NPD

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296000000000",
    "number": "1144339995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 US HIGHWAY 31 S",
            "address_2": "SUITE D",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356113645",
            "telephone_number": "256-232-8274",
            "fax_number": "256-232-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 US HIGHWAY 31 S",
            "address_2": "SUITE D",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356113645",
            "telephone_number": "256-232-8274",
            "fax_number": "256-232-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENS CREEKSIDE DRUGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2011-01-26",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "256-232-8274",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AL",
            "license": "111879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10003175",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Athens and Limestone County Healthcare Authority (Athens Limestone CRNA Group)
• Athens Chiropractic PC
• Athens City School District
• Athens Community Care
• Athens Convalescent Center (Athens Nursing Home)
• Athens Dental Services
• Athens Eye Care Center, P.C.
• Athens Eye Clinic, PC
• Athens Family Care, Dba
• Athens Family Care, LLC

• Pharmacist in Athens, AL
• Providers in Athens, AL by specialty
• Pharmacist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.