Jefferson Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH28757 Issued in FL

Legal business name

JEFFERSON PHARMACY LLC

Doing business as

Jefferson Pharmacy, LLC

Practice address

2683 Saint Johns Bluff Rd S Ste 127
Jacksonville, FL 32246-3765

Phone

(904) 516-8278

Fax

(904) 513-9293

NPI assigned

Dec 22, 2014

Last updated

Jan 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Craig Johanson

Title

Owner/Manager

Phone

(904) 638-9515

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jefferson Pharmacy, LLC Doing business as

Locations

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

{
    "created_epoch": "1419206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1891193017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2683 SAINT JOHNS BLUFF RD S STE 127",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322463765",
            "telephone_number": "904-516-8278",
            "fax_number": "904-647-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2683 SAINT JOHNS BLUFF RD S STE 127",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322463765",
            "telephone_number": "904-516-8278",
            "fax_number": "904-513-9293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-22",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "JOHANSON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "904-638-9515"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH28757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2149467",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Robert Jedrziewski, LMHC, LMFT
• Jeff Jacqmein MD,PA
• Jefferson Caregiving Services
• Janet Jefferson Hastings
• Jefferson Health Care (Felicia Jefferson)
• Andrevius T Jefferson, PA
• Britany Jefferson, OT
• Casandra Denise Jefferson
• Courtney Alexis Jefferson, LPN
• Felicia Jefferson

• Community/Retail Pharmacy in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.