Jackson Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2009003117 Issued in MO

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

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Donald Schreiber

Title

President

Phone

(314) 965-4700

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• MediCenter Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MO4 enrollments

Enrollment records 4

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.

• Jackson Pharmacy Inc

  • Long Term Care Pharmacy
  • Jackson, MO
  • NPI 1790547701
  NPD tax ID

Locations

Practitioners 2

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

• Christina Diane Hart, PHARMD

  • Pharmacist
  • Jackson, MO
  • NPI 1154950764
  NPD (past)
• Heather Michelle Weber, PHARMD

  • Pharmacist
  • Jackson, MO
  • NPI 1063030476
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1811075336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W WASHINGTON ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637551858",
            "telephone_number": "314-965-4700",
            "fax_number": "573-243-1254"
        },
        {
            "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": "2006-11-01",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "SCHREIBER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-965-4700"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2009003117",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2119180",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602650608",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MediCenter Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jackson Dental, LLC
• Jackson Family Clinic, Inc
• Jackson Manor Healthcare, LLC
• Jackson Medical Center PC
• Jackson Pharmacy Inc
• Jackson Physical Therapy & Rehabilitation, Inc.
• Jackson Primary Care LLC
• Jackson Primary Care LLC
• Jackson R-2 Schools
• Stephanie Jansen, DC

• Community/Retail Pharmacy in Jackson, MO
• Providers in Jackson, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.