NPIMap

Organization Active NPI

Kleins of Jacksonville Inc

  • Clinic Pharmacy
  • Phoenix, MD
National Provider Identifier
1215567011
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
KLEINS OF JACKSONVILLE INC
Practice address
14330 Jarrettsville Pike
Phoenix, MD 21131-1743
Phone
(410) 666-1700
NPI assigned
Jan 21, 2020
Last updated
Jan 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

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

Authorized official

Name
Frank Robert HendersonNPI 1336222942
Title
Pharmacy Director
Phone
(410) 420-8220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X Primary

Addresses

Primary practice location

14330 Jarrettsville Pike
Phoenix, MD 21131-1743

Mailing address

2101 Rock Spring Rd
Forest Hill, MD 21050-2617
Phone (410) 420-8224

Other identifiers 1

IdentifierTypeStateIssuer
001843100MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Klein's Shoprite Pharmacy 5632 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14330 Jarrettsville Pike
Phoenix, MD 21131
Phone (410) 666-1700

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1215567011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 ROCK SPRING RD",
            "city": "FOREST HILL",
            "state": "MD",
            "postal_code": "210502617",
            "telephone_number": "410-420-8224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14330 JARRETTSVILLE PIKE",
            "city": "PHOENIX",
            "state": "MD",
            "postal_code": "211311743",
            "telephone_number": "410-666-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLEINS OF JACKSONVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "410-420-8220"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001843100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.