Jefferson Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY47083 Issued in CA

Legal business name

JEFFERSON PHARMACY

Doing business as

Jefferson Pharmacy

Practice address

1029 Jefferson Blvd Ste a
West Sacramento, CA 95691-3344

Phone

(916) 371-2022

Fax

(916) 371-2027

NPI assigned

Nov 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Beatle Tran, RPH

Title

Owner

Phone

(916) 371-2022

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• JEFFERSON PHARMACY Doing business as

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1699846774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 JEFFERSON BLVD STE A",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956913344",
            "telephone_number": "916-371-2022",
            "fax_number": "916-371-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 JEFFERSON BLVD STE A",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956913344",
            "telephone_number": "916-371-2022",
            "fax_number": "916-371-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "BEATLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-371-2022",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY47083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821081910",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2115818",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JEFFERSON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chanin Amrek James Hardwick, LPCC
• Lynnee T January, D.C.
• Jefferson Pharmacy
• Jefferson Pharmacy
• Jefferson Pharmacy
• Leiaha Samantha Jeffery-Howard
• Jeremy V Johnson
• Joshua Johnson
• Kira Nicole Johnson
• Mary Anna Johnson, CCC-SLP

• Community/Retail Pharmacy in West Sacramento, CA
• Providers in West Sacramento, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; 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.