Jerome D. Jackson

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

312 Issued in AK

Legal business name

JEROME D. JACKSON

Doing business as

Medical Center Pharmacy

Practice address

1867 Airport Way
Suite 105
Fairbanks, AK 99701-4007

Phone

(907) 452-2328

NPI assigned

Mar 26, 2007

Organization subpart

No

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

Authorized official

Name

Jerome D Jackson

Title

Owner Pharmacist

Phone

(907) 452-2328

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• MEDICAL CENTER PHARMACY Doing business as

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1376661934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY",
            "address_2": "SUITE 105",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014007",
            "telephone_number": "907-452-2328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY",
            "address_2": "SUITE 105",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014007",
            "telephone_number": "907-452-2328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME D. JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER PHARMACIST",
        "authorized_official_telephone_number": "907-452-2328"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AK",
            "license": "312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "0200624",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MSO268",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHO268",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katelyn A Jensen, CSFA
• Paul L Jensen, MD
• Sarah Jensen, LCSW
• Valerie Jensen, LCSW
• Nam Wook Jeon, L. AC
• Matthew Jeselnik
• Leona Lynn Jewell
• Shan Jiang, MD
• Amber Jimmie
• Andrean Joyce Jimmie

• Durable Medical Equipment & Medical Supplies in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Durable Medical Equipment & Medical Supplies in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.