Active NPI
Jessica Anne Clubb, PHARM.D.
- Pharmacist
- San Rafael, CA
National Provider Identifier
1194093351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 60858
- Practice address
- 950 Las Gallinas Ave
Safeway Pharmacy
San Rafael, CA 94903 - Phone
- (415) 472-8221
- NPI assigned
- Dec 2, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 60858 | CA | Primary |
Addresses
Primary practice location
950 Las Gallinas Ave
Safeway Pharmacy
San Rafael, CA 94903
Mailing address
950 Las Gallinas Ave
Safeway Pharmacy
San Rafael, CA 94903
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60858 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351728000000",
"number": "1194093351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 LAS GALLINAS AVE",
"address_2": "SAFEWAY PHARMACY",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 LAS GALLINAS AVE",
"address_2": "SAFEWAY PHARMACY",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94903",
"telephone_number": "415-472-8221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLUBB",
"first_name": "JESSICA",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-02",
"last_updated": "2012-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "60858",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.