Edward Jackson

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

0230034593 Issued in VA

Practice address

11214 Jefferson Ave
Newport News, VA 23601-2207

Phone

(757) 327-7478

NPI assigned

Mar 29, 2021

Last updated

Mar 29, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Wal-Mart Stores East LP

  dba Wal-Mart Pharmacy 10-3157

  • Community/Retail Pharmacy
  • Newport News, VA
  • NPI 1386988715
  NPD (past)
• Wal-Mart Stores East, LP

  dba Walmart Pharmacy 10-2229

  • Pharmacy
  • Apollo Beach, FL
  • NPI 1437027208
  NPD (past)

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1386222859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11214 JEFFERSON AVE",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236012207",
            "telephone_number": "757-327-7478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11214 JEFFERSON AVE",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236012207",
            "telephone_number": "757-327-7478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EDWARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-29",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "VA",
            "license": "0230034593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY TECHNICIAN LICENSE",
            "identifier": "0230034593",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "walmart.com",
            "affiliation": "N",
            "address_1": "11214 Jefferson Ave",
            "city": "Newport News",
            "state": "VA",
            "country_code": "US",
            "postal_code": "236012207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• J. Dewey Willis III, D.D.S., P.C., & Assoc.
• J. F. Foretich, Jr., D.D.S. (a division of Atlantic Dental Care)
• Annabel Grace Jackson, PA-C
• Cara Marie Jackson, D.O.
• Christian Jackson, SLP
• Jason Jackson
• Lacey J Jackson, PHARMD
• Makayla Azaria Jackson
• Meria Eisenbraun Jackson, CRNA, MSN
• Michele Eloise Jackson, RESIDENT IN COUNSELI

• Pharmacy Technician in Newport News, VA
• Providers in Newport News, VA by specialty
• Pharmacy Technician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.