Active NPI
Randy Eugene Jackson Jr., PHARMD
- Pharmacist
- Wilmington, DE
National Provider Identifier
1700506300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- A1-0015767
- Practice address
- 501 W 14TH St
Wilmington, DE 19801-1013 - Phone
- (302) 320-2108
- NPI assigned
- Sep 1, 2022
- Last updated
- Sep 1, 2022
- 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 | A1-0015767 | DE | Primary |
Addresses
Primary practice location
501 W 14TH St
Wilmington, DE 19801-1013
Mailing address
453 Greenwood Dr
Wilmington, DE 19808-1961
Phone (252) 775-0398
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rand.jackson@christianacare.org |
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 |
|---|---|---|---|
| A1-0015767 | DE | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661990400000",
"number": "1700506300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "453 GREENWOOD DR",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198081961",
"telephone_number": "252-775-0398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 W 14TH ST",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198011013",
"telephone_number": "302-320-2108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RANDY",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-01",
"last_updated": "2022-09-01",
"certification_date": "2022-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "DE",
"license": "A1-0015767",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rand.jackson@christianacare.org",
"affiliation": "N",
"address_1": "501 W 14th St",
"city": "Wilmington",
"state": "DE",
"country_code": "US",
"postal_code": "198011013",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.