Active NPI
Melissa A Jackson, PHARMD
- Pharmacist
- Baton Rouge, LA
National Provider Identifier
1417264490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18417
- Practice address
- 11297 Florida Blvd
Baton Rouge, LA 70815-2015 - Phone
- (225) 272-9769
- NPI assigned
- Sep 11, 2010
- Sex
- Female
- 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 | 18417 | LA | Primary |
Addresses
Primary practice location
11297 Florida Blvd
Baton Rouge, LA 70815-2015
Mailing address
600 Penn Dr
La Place, LA 70068-3630
Phone (985) 652-4788
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 |
|---|---|---|---|
| 18417 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Louisiana Co Inc | Past | Accepting new patients | |
| Walgreen Louisiana Co Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284163200000",
"number": "1417264490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 PENN DR",
"city": "LA PLACE",
"state": "LA",
"postal_code": "700683630",
"telephone_number": "985-652-4788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11297 FLORIDA BLVD",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708152015",
"telephone_number": "225-272-9769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MELISSA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-11",
"last_updated": "2010-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "18417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.