Mt Jackson Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0201002587 Issued in VA

Legal business name

MT JACKSON DRUG STORE INC

Doing business as

Mt Jackson Drug Store

Practice address

5350 Main St
Mount Jackson, VA 22842-9511

Phone

(540) 477-3101

Fax

(540) 477-4039

NPI assigned

Oct 20, 2006

Last updated

Aug 16, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James Fansler

Title

President Owner

Phone

(540) 477-3101

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• MT JACKSON DRUG STORE Doing business as

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471305600000",
    "number": "1346322120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 473",
            "city": "MOUNT JACKSON",
            "state": "VA",
            "postal_code": "228420473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 MAIN ST",
            "city": "MOUNT JACKSON",
            "state": "VA",
            "postal_code": "228429511",
            "telephone_number": "540-477-3101",
            "fax_number": "540-477-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT JACKSON DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2016-08-16",
        "status": "A",
        "authorized_official_last_name": "FANSLER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "540-477-3101"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201002587",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010078059",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2102235",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MT JACKSON DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica R Jaindl, FNP-C
• Robert E. Keeton, MD
• Carol A Kelley
• Jared Alan Morris
• Mount Jackson Dental Care, PLLC
• Mt. Jackson Family Health
• Kathleen L Muiruri, M.D.
• Venkata Satish Nagineni
• North Mountain Dietetic Services, LLC
• Janet L Polansky, MD

• Community/Retail Pharmacy in Mount Jackson, VA
• Providers in Mount Jackson, VA by specialty
• Community/Retail Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; 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.