James D Jackson Jr., R.PH.

Key facts

NPI

1154447076

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

E-08477 (MS)

Practice address

28271 Highway 15
Walnut, MS 38683-8930

Phone

(662) 223-4727

Fax

(662) 223-5899

NPI assigned

Mar 22, 2007

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Pharmacist

State licenses

Specialties & licenses

Addresses

Other names

• Jim D Jackson Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 13, 2017.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513123200000",
    "number": "1154447076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 COUNTY ROAD 225",
            "city": "WALNUT",
            "state": "MS",
            "postal_code": "386839279",
            "telephone_number": "662-223-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28271 HIGHWAY 15",
            "city": "WALNUT",
            "state": "MS",
            "postal_code": "386838930",
            "telephone_number": "662-223-4727",
            "fax_number": "662-223-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JAMES",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2017-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-08477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JIM",
            "last_name": "JACKSON",
            "middle_name": "D",
            "credential": "R.PH.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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