Active NPI
Patrick Dale Jackson, PHARM. D.
- Pharmacist
- Gardena, CA
National Provider Identifier
1295341097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 46393
- Practice address
- 19300 S Hamilton Ave Ste 170-180
Gardena, CA 90248-4400 - Phone
- (310) 464-8241
- NPI assigned
- Sep 17, 2020
- Sex
- Male
- 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 | 46393 | CA | Primary |
Addresses
Primary practice location
19300 S Hamilton Ave Ste 170-180
Gardena, CA 90248-4400
Mailing address
1958 N Gower St
Los Angeles, CA 90068-4009
Phone (213) 924-5006
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 |
|---|---|---|---|
| 46393 | CA | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| AIDS Healthcare Foundation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Retail Pharmacy
- Baton Rouge, LA
- NPI 1891525184
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600300800000",
"number": "1295341097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1958 N GOWER ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900684009",
"telephone_number": "213-924-5006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19300 S HAMILTON AVE STE 170-180",
"city": "GARDENA",
"state": "CA",
"postal_code": "902484400",
"telephone_number": "310-464-8241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "PATRICK",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-17",
"last_updated": "2020-09-17",
"certification_date": "2020-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "46393",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.