Active NPI
Jessica Czajkowski Vera
- Pharmacist
- South Bend, IN
National Provider Identifier
1851017412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26029849A
- Practice address
- 4403 W Western Ave
South Bend, IN 46619-2640 - Phone
- (574) 234-3241
- NPI assigned
- Oct 17, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 26029849A | IN | Primary |
Addresses
Primary practice location
4403 W Western Ave
South Bend, IN 46619-2640
Mailing address
4403 W Western Ave
South Bend, IN 46619-2640
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26029849A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hook-Superx LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665964800000",
"number": "1851017412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4403 W WESTERN AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466192640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4403 W WESTERN AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466192640",
"telephone_number": "574-234-3241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERA",
"first_name": "JESSICA",
"middle_name": "CZAJKOWSKI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-17",
"last_updated": "2022-10-17",
"certification_date": "2022-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26029849A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.