Active NPI
Jaketa Maria Stoudmire Marzok, M.S., PHARMD, RPH
- Pharmacist
- Birmingham, AL
National Provider Identifier
1639432123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03232623
- Practice address
- 220 Gadsden Hwy
Birmingham, AL 35235-1006 - Phone
- (205) 836-8344
- NPI assigned
- Jun 19, 2012
- Last updated
- Dec 2, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03232623 | OH | Primary |
| Pharmacist | 183500000X | 19188 | AL |
Addresses
Primary practice location
220 Gadsden Hwy
Birmingham, AL 35235-1006
Mailing address
220 Gadsden Hwy
Birmingham, AL 35235-1006
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
- Master of Science, Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19188 | AL | MD | Pharmacist |
| 03232623 | OH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alabama CVS Pharmacy, L.L.C. | Current | Accepting new patients | |
| Alabama CVS Pharmacy LLC | Past | Accepting new patients |
Locations
220 Gadsden Hwy
Birmingham, AL 35235
Phone (205) 836-8344
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": "1340064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606867200000",
"number": "1639432123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 GADSDEN HWY",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352351006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 GADSDEN HWY",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352351006",
"telephone_number": "205-836-8344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUDMIRE MARZOK",
"first_name": "JAKETA",
"middle_name": "MARIA",
"name_prefix": "Mrs.",
"credential": "M.S., PHARMD, RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-19",
"last_updated": "2020-12-02",
"certification_date": "2020-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03232623",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "19188",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.