James Edward Blackburn Jr.

Primary specialty

PharmacistTaxonomy code 183500000X

License

3585 Issued in WY

Practice address

150 Scott LN SPC a
Jackson, WY 83001-8467

Phone

(307) 201-1159

Fax

(307) 201-1553

NPI assigned

Oct 22, 2012

Last updated

Feb 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Blackburn Drug LLC

  dba Blackburn Drug

  • Compounding Pharmacy
  • Jackson, WY
  • NPI 1275109340
  NPD Authorized official
• Sundance International Trading Co.

  dba Stone Drug

  • Community/Retail Pharmacy
  • Jackson, WY
  • NPI 1598084121
  NPD (past)

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

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1710230230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11540",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830021540",
            "telephone_number": "540-809-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SCOTT LN SPC A",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018467",
            "telephone_number": "307-201-1159",
            "fax_number": "307-201-1553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "830 W Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "WY",
            "postal_code": "830018647",
            "country_code": "US",
            "telephone_number": "307-733-6222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "JAMES",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-22",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WY",
            "license": "3585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trudylynn Birkemeyer Funk, LCSW
• Kelly J Biscombe, APRN
• Kimberly Bjorkman
• Leah Black, LCSW
• Blackburn Drug LLC (Blackburn Drug)
• Philip C Blum, MD
• Peter G. Blumenauer, DC
• Jasmine Blunt, DNP
• Carol Bocker, SLP
• Jonathan Peter Boltax, MD

• Pharmacist in Jackson, WY
• Providers in Jackson, WY by specialty
• Pharmacist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.