Active NPI
Jeffrey Clay Roberts, RPH
- Pharmacist
- Boaz, AL
National Provider Identifier
1629140652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- AL 10733
- Practice address
- 10639 Alabama Highway 168
Boaz, AL 35957 - Phone
- (256) 593-5279
- Fax
- (256) 593-1991
- NPI assigned
- Nov 14, 2006
- 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 | AL 10733 | AL | Primary |
Addresses
Primary practice location
10639 Alabama Highway 168
Boaz, AL 35957
Mailing address
809 Merit Springs Rd
Gadsden, AL 35901
Phone (256) 547-5033
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10733 | Other | AL | STATE 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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL 10733 | AL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mill Street 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
- Boaz, AL
- NPI 1295837300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629140652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "809 MERIT SPRINGS RD",
"city": "GADSDEN",
"state": "AL",
"postal_code": "35901",
"telephone_number": "256-547-5033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10639 ALABAMA HIGHWAY 168",
"city": "BOAZ",
"state": "AL",
"postal_code": "35957",
"telephone_number": "256-593-5279",
"fax_number": "256-593-1991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "JEFFREY",
"middle_name": "CLAY",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "AL 10733",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF PHARMACY",
"identifier": "10733",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boaz, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.