Active NPI
Anthony Shane Jackson, PHARM.D., BCPS
- Pharmacotherapy Pharmacist
- Tampa, FL
National Provider Identifier
1871768994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- PS36016
- Practice address
- 6001 Webb Rd
Tampa, FL 33615-3241 - Phone
- (813) 329-6062
- NPI assigned
- Apr 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS36016 | FL | |
| Nutrition Support Pharmacist | 1835N1003X | PS36016 | FL | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | PS36016 | FL | |
| Pharmacotherapy Pharmacist | 1835P1200X | PS36016 | FL | Primary |
Addresses
Primary practice location
6001 Webb Rd
Tampa, FL 33615-3241
Mailing address
2593 Grand Lakeside Dr
Palm Harbor, FL 34684-1013
Other practice location 1
3771 Tampa Rd
Oldsmar, FL 34677-3004
Phone (813) 855-5781
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS36016 | FL | MD | Nutrition Support Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612137600000",
"number": "1871768994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2593 GRAND LAKESIDE DR",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346841013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6001 WEBB RD",
"city": "TAMPA",
"state": "FL",
"postal_code": "336153241",
"telephone_number": "813-329-6062"
}
],
"practiceLocations": [
{
"address_1": "3771 Tampa Rd",
"address_purpose": "LOCATION",
"city": "Oldsmar",
"state": "FL",
"postal_code": "346773004",
"country_code": "US",
"telephone_number": "813-855-5781",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "ANTHONY",
"middle_name": "SHANE",
"name_prefix": "Dr.",
"credential": "PHARM.D., BCPS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-29",
"last_updated": "2021-02-01",
"certification_date": "2021-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS36016",
"primary": false
},
{
"code": "1835N1003X",
"taxonomy_group": "",
"desc": "Pharmacist, Nutrition Support",
"state": "FL",
"license": "PS36016",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "FL",
"license": "PS36016",
"primary": false
},
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "FL",
"license": "PS36016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.