Active NPI
Deronda Kay Back, RPH
- Pharmacist
- Jackson, KY
National Provider Identifier
1689887580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 008355
- Practice address
- 842 Hwy 15 N
Jackson, KY 41339 - Phone
- (606) 666-7060
- Fax
- (606) 666-9454
- NPI assigned
- May 7, 2007
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 008355 | KY | Primary |
Addresses
Primary practice location
842 Hwy 15 N
Jackson, KY 41339
Mailing address
PO Box 931
Jackson, KY 41339-0931
Phone (606) 666-7060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008355 | Other | KY | KY STATE LICENSE |
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 |
|---|---|---|---|
| 008355 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jordan Drug, Inc. | Past | Accepting new patients | |
| Jordan Drug, Inc. | Past | Accepting new patients |
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": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689887580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 931",
"city": "JACKSON",
"state": "KY",
"postal_code": "413390931",
"telephone_number": "606-666-7060",
"fax_number": "606-666-9454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "842 HWY 15 N",
"city": "JACKSON",
"state": "KY",
"postal_code": "41339",
"telephone_number": "606-666-7060",
"fax_number": "606-666-9454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACK",
"first_name": "DERONDA",
"middle_name": "KAY",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "008355",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KY STATE LICENSE",
"identifier": "008355",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, KY
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.