Active NPI
Pioneer Family Pharmacy
- Community/Retail Pharmacy
- Aberdeen, MS
National Provider Identifier
1932227089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 06748
- Legal business name
- PIONEER FAMILY PHARMACY
- Practice address
- 502 Jackson St
Suite 1
Aberdeen, MS 39730-3300 - Phone
- (662) 369-4249
- Fax
- (662) 304-4018
- NPI assigned
- Mar 27, 2007
- Last updated
- Mar 7, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jerry Matthew Fortenberry, RPH
- Title
- Pharmacist Ni Charge
- Phone
- (601) 937-1672
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 06748 | MS | Primary |
Addresses
Primary practice location
502 Jackson St
Suite 1
Aberdeen, MS 39730-3300
Mailing address
502 Jackson St
Suite 1
Aberdeen, MS 39730-3300
Phone (662) 369-4249
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2586317 | Other | MI | NABP |
| 06229094 | Medicaid | MI |
National Provider Directory
National Provider Directory- Tax ID family
- Pioneer Health SVCS of
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Pioneer Walk In Clinic
- Clinic/Center
- Aberdeen, MS
- NPI 1477929495
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1932227089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "502 JACKSON ST",
"address_2": "SUITE 1",
"city": "ABERDEEN",
"state": "MS",
"postal_code": "397303300",
"telephone_number": "662-369-4249",
"fax_number": "662-304-4018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 JACKSON ST",
"address_2": "SUITE 1",
"city": "ABERDEEN",
"state": "MS",
"postal_code": "397303300",
"telephone_number": "662-369-4249",
"fax_number": "662-304-4018"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PIONEER FAMILY PHARMACY",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-27",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "FORTENBERRY",
"authorized_official_first_name": "JERRY",
"authorized_official_middle_name": "MATTHEW",
"authorized_official_title_or_position": "PHARMACIST NI CHARGE",
"authorized_official_telephone_number": "601-937-1672",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MS",
"license": "06748",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP",
"identifier": "2586317",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06229094",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aberdeen, MS
- Medicomp, Inc (Medicomp Physical Therapy Aberdeen)
- Mississippi State Department of Health
- Kristen Shay O'Brian, PHARM D
- Joel Nathaneal Patterson, PHARMD
- Natalie L Pierce, OTR/L
- Pioneer Health Services of Monroe County, Inc (Chestnut Medical Clinic)
- Pioneer Health Services of Monroe County, Inc (Pioneer Community Hospital of Aberdeen Swing Bed)
- Pioneer Health Services of Monroe County, Inc (Pioneer Pediatric Clinic)
- Pioneer Health Services of Monroe County, Inc (Nina Jurney Family Medical Practice)
- Pioneer Health Services of Monroe County, Inc. (Pioneer Community Hospital of Aberdeen)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.