Melvin Jackson III, PD

Primary specialty

PharmacistTaxonomy code 183500000X

License

14588 Issued in LA

Practice address

920 W Gloria Switch Rd
Lafayette, LA 70507-2310

Phone

(337) 896-0128

NPI assigned

Aug 19, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Walgreen Co

  • Pharmacy
  • Lafayette, LA
  • NPI 1154651438
  NPD
• Walgreen Co

  • Pharmacy
  • Opelousas, LA
  • NPI 1114932381
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1508172214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 W GLORIA SWITCH RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705072310",
            "telephone_number": "337-896-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 W GLORIA SWITCH RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705072310",
            "telephone_number": "337-896-0128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 Creswell Ln",
            "address_purpose": "LOCATION",
            "city": "Opelousas",
            "state": "LA",
            "postal_code": "705705810",
            "country_code": "US",
            "telephone_number": "337-942-4228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELVIN",
        "name_suffix": "III",
        "credential": "PD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-19",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "14588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jade Raven Jackson
• Jared Jackson
• Jennifer Jackson, R.D.
• Marcko Jackson
• Matthew Jackson
• Micaela Shanta Jackson
• Natasha Jackson
• Nia Angaline Jackson
• Reginald D Jackson
• Shanel S. Jackson, M.A.

• Pharmacist in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Pharmacist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.