Miranda Hulett Jackson, PHARM D

Primary specialty

PharmacistTaxonomy code 183500000X

License

014548 Issued in KY

Practice address

711 Campbell LN
Bowling Green, KY 42104-1040

Phone

(270) 843-2383

Fax

(270) 783-8687

NPI assigned

Mar 23, 2011

Last updated

Mar 23, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kroger Limited Partnership I

  dba Kroger Pharmacy #473

  • Community/Retail Pharmacy
  • Newport, KY
  • NPI 1104791078
  NPD (past)
• Kroger Limited Partnership I

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Bowling Green, KY
  • NPI 1376577197
  NPD (past)

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

{
    "created_epoch": "1300838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300838400000",
    "number": "1306145867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 CAMPBELL LN",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421041040",
            "telephone_number": "270-843-2383",
            "fax_number": "270-783-8687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 CAMPBELL LN",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421041040",
            "telephone_number": "270-843-2383",
            "fax_number": "270-783-8687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MIRANDA",
        "middle_name": "HULETT",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-23",
        "last_updated": "2011-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "014548",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "0000033743",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eli O. Jackson, D.M.D.
• Kevin Ryan Jackson, O.D.
• Lori Ann Jackson, ARNP
• Megan Kay Jackson, APRN
• Milton Schreiner Jackson, MD
• Sheena N Jackson
• Veronica Jackson
• Jennifer A Jacobs, SLP
• Beverly G. Jaggers, APRN
• Manisha Jain, MD

• Pharmacist in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Pharmacist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; 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.