Active NPI
Amy Sue Jackson, RPH
- Pharmacist
- Greenville, SC
National Provider Identifier
1932320355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11715
- Practice address
- 1141 State Park Rd
Greenville, SC 29609-1518 - Phone
- (864) 240-7421
- NPI assigned
- May 2, 2007
- Last updated
- Jul 12, 2013
- 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 | 11715 | SC | Primary |
Addresses
Primary practice location
1141 State Park Rd
Greenville, SC 29609-1518
Mailing address
6 Granite Woods Way
Greer, SC 29650-5325
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11715 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Carolina CVS Pharmacy, L.L.C. | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373587200000",
"number": "1932320355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 GRANITE WOODS WAY",
"city": "GREER",
"state": "SC",
"postal_code": "296505325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1141 STATE PARK RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296091518",
"telephone_number": "864-240-7421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "AMY",
"middle_name": "SUE",
"name_prefix": "Dr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2013-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "11715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.