Active NPI
Jamie Virginia Hack Gordon, PHARM.D.
- Pharmacist
- Fort Carson, CO
National Provider Identifier
1477835742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS45154
- Practice address
- 1650 Cochrane Cir
Fort Carson, CO 80913-4613 - Phone
- (719) 526-7410
- NPI assigned
- Sep 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202214400 | VA | |
| Pharmacist | 183500000X | PHA.0023069 | CO | |
| Pharmacist | 183500000X | RP0012244 | WV | |
| Pharmacist | 183500000X | PS45154 | FL | Primary |
Addresses
Primary practice location
1650 Cochrane Cir
Fort Carson, CO 80913-4613
Mailing address
9855 Hunting TR
Lake Worth, FL 33467-3515
Phone (561) 968-3330
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHA.0023069 | Other | CO | COLORADO BOARD OF PHARMACY |
| RP0012244 | Other | WV | WEST VIRGINIA BOARD OF PHARMACY |
| 0202214400 | Other | VA | VIRGINIA BOARD OF PHARMACY |
| PS45154 | Other | FL | FLORIDA BOARD OF PHARMACY |
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 |
|---|---|---|---|
| PHA.0023069 | CO | MD | Pharmacist |
| PS45154 | FL | MD | Pharmacist |
| 0202214400 | VA | MD | Pharmacist |
| RP0012244 | WV | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634774400000",
"number": "1477835742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9855 HUNTING TR",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334673515",
"telephone_number": "561-968-3330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 COCHRANE CIR",
"city": "FORT CARSON",
"state": "CO",
"postal_code": "809134613",
"telephone_number": "719-526-7410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACK GORDON",
"first_name": "JAMIE",
"middle_name": "VIRGINIA",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-13",
"last_updated": "2021-10-21",
"certification_date": "2021-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202214400",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "PHA.0023069",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0012244",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS45154",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLORADO BOARD OF PHARMACY",
"identifier": "PHA.0023069",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WEST VIRGINIA BOARD OF PHARMACY",
"identifier": "RP0012244",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIRGINIA BOARD OF PHARMACY",
"identifier": "0202214400",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA BOARD OF PHARMACY",
"identifier": "PS45154",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Carson, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.