Active NPI
Brian Lee Jackson, PHARMD
- Pharmacist
- Byram, MS
National Provider Identifier
1558973115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-12966
- Practice address
- 5780 Terry Rd
Byram, MS 39272-9745 - Phone
- (601) 346-2553
- NPI assigned
- Aug 17, 2020
- Last updated
- Aug 17, 2020
- Sex
- Male
- 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 | E-12966 | MS | Primary |
Addresses
Primary practice location
5780 Terry Rd
Byram, MS 39272-9745
Mailing address
500 Northpointe Pkwy Apt 316
Jackson, MS 39211-1606
Phone (228) 209-4624
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 |
|---|---|---|---|
| E-12966 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
5780 Terry Rd
Byram, MS 39272
Phone (601) 346-2553
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597622400000",
"number": "1558973115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 NORTHPOINTE PKWY APT 316",
"city": "JACKSON",
"state": "MS",
"postal_code": "392111606",
"telephone_number": "228-209-4624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5780 TERRY RD",
"city": "BYRAM",
"state": "MS",
"postal_code": "392729745",
"telephone_number": "601-346-2553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BRIAN",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-17",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-12966",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Byram, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.