Active NPI
Ellen Gilbert Jackson, RPH
- Pharmacist
- La Fayette, GA
National Provider Identifier
1710013099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16389
- Practice address
- 324 Patton Street
Medithrift Pharmacy
La Fayette, GA 30728 - Phone
- (706) 638-3114
- NPI assigned
- Feb 23, 2007
- Last updated
- Jul 8, 2007
- 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 | 16389 | GA | Primary |
| Pharmacist | 183500000X | 9672 | AL |
Addresses
Primary practice location
324 Patton Street
Medithrift Pharmacy
La Fayette, GA 30728
Mailing address
480 N Ridge Dr
La Fayette, GA 30728-4737
Phone (706) 638-2981
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 |
|---|---|---|---|
| 9672 | AL | MD | Pharmacist |
| 16389 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medi Thrift Inc | Past | Accepting new patients | |
| Medi Thrift 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.
-
- Community/Retail Pharmacy
- La Fayette, GA
- NPI 1790840619
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710013099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "480 N RIDGE DR",
"city": "LA FAYETTE",
"state": "GA",
"postal_code": "307284737",
"telephone_number": "706-638-2981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 PATTON STREET",
"address_2": "MEDITHRIFT PHARMACY",
"city": "LA FAYETTE",
"state": "GA",
"postal_code": "30728",
"telephone_number": "706-638-3114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ELLEN",
"middle_name": "GILBERT",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "16389",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "9672",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Fayette, GA
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.