JACKSON DRUG CO (NPI# 1053456889) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053456889 |
| Entity Type | Organization |
| Organization Name | JACKSON DRUG CO |
| Other Organization Name | JACKSON DRUG |
| Practice Address |
506 2nd St Jackson MN 56143-0233 |
| Practice Telephone | 5078473161 |
| Practice Fax Number | 5078472480 |
| Mailing Telephone | 5078473461 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-08-13 |
| Authorized Official Name | LANCE EDLIN (OWNER) |
| Authorized Official Telephone | 5078473161 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | 22124900 | MN | Suppliers |
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| N | 3336M0003X |
Pharmacy Specialization: Managed Care Organization Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 2405632 | 01 |
| Other Name | Type Code |
|---|---|
| JACKSON DRUG | Doing Business As Name - Organization |
| Street Address |
506 2ND ST |
| City | JACKSON |
| State | MN |
| Zip Code | 56143-0233 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083896716 | Shopko Stores Operating Co LLC | Pharmacy | 506 2nd St, Jackson, MN 56143 | 2007-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063576965 | Jackson County Central Schools | Local Education Agency (LEA) | Jackson County Central Schools, 1128 North Highway, Jackson, MN 56143 | 2006-12-22 |
| 1609952027 | Susan Marie Back | Psychologist | 116 County Road 34 W, Jackson, MN 56143 | 2006-10-27 |
| 1992805204 | Kevin John Dunlavey | Dentist | 607 2nd St, Jackson, MN 56143 | 2006-09-25 |
| 1285978221 | Paul Anthony Roggow | Dentist | 604 Second Street, Jackson, MN 56143 | 2012-11-15 |
| 1811915648 | Jackson Volunteer Ambulance | Ambulance | 305 Sheridan Str, Jackson, MN 56143-0242 | 2006-07-18 |
| 1750378758 | Sister Marie Paul Lockerd | Family Medicine | 803 4th St, Jackson, MN 56143-1056 | 2005-10-04 |
| 1407065824 | Desmoines Valley Bhs | Clinical Nurse Specialist | 803 4th St, Jackson, MN 56143-1056 | 2007-05-22 |
| 1942426689 | Margaret Jean Hart | Family Medicine | 803 4th St, Jackson, MN 56143-1056 | 2007-04-18 |
| 1003912171 | Sacred Heart Mercy Health Care Center | Family Medicine | 803 4th St, Jackson, MN 56143-1056 | 2006-09-16 |
| 1982655213 | Michele Gloria Paradis | Registered Nurse | 803 4th St, Jackson, MN 56143-1056 | 2006-05-12 |
| Find all providers in zip 56143 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144874868 | Whitney Harris Drugs, Inc. | Pharmacy | 1200 Eastover Dr Ste 175, Jackson, MS 39211-6317 | 2019-07-31 |
| 1013576826 | Avita Drugs Mississippi, LLC | Pharmacy | 805 E River Pl Ste A, Jackson, MS 39202-3486 | 2019-06-06 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| 1952823783 | Teton County Hospital District | Pharmacy | 555 E Broadway Ave Ste 212, Jackson, WY 83001-8640 | 2017-07-13 |
| 1477955037 | Jackson Village Pharmacy LLC | Pharmacy | 27 South Cooks Bridge Rd, Suite M1, Jackson, NJ 08527 | 2014-09-25 |
| 1215341623 | Rite Aid | Pharmacy | 702 Bennett Mills Road, Jackson, NJ 08527 | 2014-06-13 |
| 1134251812 | Main Midtown Inc | Pharmacy | 346 E Fortification St, Jackson, MS 39202-2325 | 2007-03-09 |
| 1003943176 | Ljc,inc Dba Stone Drug | Pharmacy | 830 West Broadway, Box 9000, Jackson, WY 83001 | 2007-02-27 |
| 1003968322 | Carel Pharmacy | Pharmacy | 2010 W County Line Rd, Jackson, NJ 08527-2001 | 2007-01-17 |
| 1316095573 | Gold Kimball International, Inc. | Pharmacy | 2080 W County Line Rd, Jackson, NJ 08527-2015 | 2007-01-06 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.