Active NPI
Lonnie Everrett Jackson III, P.D.
- Pharmacist
- Batesville, AR
National Provider Identifier
1477637841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD06643
- Practice address
- 1305 White Dr
Batesville, AR 72501-9467 - Phone
- (870) 698-1974
- Fax
- (870) 698-0141
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | PD06643 | AR | Primary |
Addresses
Primary practice location
1305 White Dr
Batesville, AR 72501-9467
Mailing address
1305 White Dr
P.O. Box 2114
Batesville, AR 72501-9467
Phone (870) 698-1974
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0413396 | Other | NABP# |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD06643 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Retail Pharmacy
- Batesville, AR
- NPI 1770570491
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1477637841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 WHITE DR",
"address_2": "P.O. BOX 2114",
"city": "BATESVILLE",
"state": "AR",
"postal_code": "725019467",
"telephone_number": "870-698-1974",
"fax_number": "870-698-0141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 WHITE DR",
"city": "BATESVILLE",
"state": "AR",
"postal_code": "725019467",
"telephone_number": "870-698-1974",
"fax_number": "870-698-0141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LONNIE",
"middle_name": "EVERRETT",
"name_suffix": "III",
"credential": "P.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD06643",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP#",
"identifier": "0413396",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Batesville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.