NPIMap

Organization Active NPI

Jackson Pharmacy Inc

  • Long Term Care Pharmacy
  • Jackson, MO
National Provider Identifier
1790547701
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
JACKSON PHARMACY INC
Doing business as
Medicenter Pharmacy
Practice address
200 W Washington St
Jackson, MO 63755-1858
Phone
(573) 243-1303
Fax
(573) 243-1254
NPI assigned
Jan 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Stephen Sommer
Title
President
Phone
(314) 965-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

200 W Washington St
Jackson, MO 63755-1858

Mailing address

755 S New Ballas Rd Ste 260
Saint Louis, MO 63141-8744
Phone (314) 965-4700

Other names 1

  • Medicenter Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jackson Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1706140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1790547701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 S NEW BALLAS RD STE 260",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418744",
            "telephone_number": "314-965-4700",
            "fax_number": "314-965-4706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W WASHINGTON ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637551858",
            "telephone_number": "573-243-1303",
            "fax_number": "573-243-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "SOMMER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-965-4700"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicenter Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.