Thomas K Jackson II, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

068486 Issued in NY

Practice address

1710 Route 112
Coram, NY 11727-2270

Phone

(646) 580-1696

Fax

(631) 476-5365

NPI assigned

Nov 7, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

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 and National Provider Directory roles.

• Scripts on 43Rd Inc

  • Community/Retail Pharmacy
  • Corona, NY
  • NPI 1295592657
  NPD

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

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1881302115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 ROUTE 112",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117272270",
            "telephone_number": "646-580-1696",
            "fax_number": "631-476-5365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 ROUTE 112",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117272270",
            "telephone_number": "646-580-1696",
            "fax_number": "631-476-5365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THOMAS",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-07",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "068486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rx03100@cvshealth.com",
            "affiliation": "Y",
            "endpointDescription": "Store Email",
            "affiliationName": "CVS ALBANY LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1710 Route 112",
            "city": "Coram",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117272270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lisa Marie Isaac
• Eric Ishman, CASAC
• Island Sports Physical Therapy of Coram PC
• Lashana Jackson
• Natasha Jackson, RN
• Francine Jacobs, MD
• Sachique James
• Janine Colasuonno, Licensed Mental Health Counselor, PLLC
• Paulette Jarrett-Smith, MA
• Alixzondra S Jasmin, LPN

• Pharmacist in Coram, NY
• Providers in Coram, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.

Verify at the official NPI Registry.