DR. KENNETH CONRAD JACKSON II (NPI# 1275514994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275514994 |
| Entity Type | Individual |
| Full Name | DR. KENNETH CONRAD JACKSON II |
| Credential | PHARM.D., R.PH. |
| Practice Address |
546 Chipeta Way Suite 220 Salt Lake City UT 84108-1236 |
| Mailing Address |
2731 Hartford St Salt Lake City UT 84106-3652 |
| Practice Telephone | 8015817246 |
| Practice Fax Number | 8015816243 |
| Mailing Telephone | 8014872169 |
| Mailing Fax Number | 8015816243 |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2007-08-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1835P1200X |
Pharmacist Specialization: Pharmacotherapy |
363584-1701 | UT | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174083810 | Kenneth Jason Jackson | Student in an Organized Health Care Education/Training Program | 320 23rd St S Apt 1418, Arlington, VA 22202-3773 | 2019-03-20 |
| 1639469026 | Kenneth T Jackson | Counselor | 25506 Virginia Dr, Warren, MI 48091-6002 | 2011-04-19 |
| 1396968863 | Kenneth J Jackson | Dentist | 809 Redskin Trail, Wapakoneta, OH 45895 | 2007-04-11 |
| 1972510352 | Kenneth Wayne Jackson | Nurse Practitioner | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2006-08-01 |
| 1487606943 | Kenneth Wade Jackson Jr. | Obstetrics & Gynecology | 22 Manningfield Dr, Fletcher, NC 28732-9457 | 2006-05-16 |
| 1407409063 | Kenneth Jackson | Technician | 1005 Terminal Way Ste 125, Reno, NV 89502-2198 | 2019-07-22 |
| 1457857690 | Kenneth D Jackson | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-05 |
| 1528573714 | Kenneth Jackson | Case Manager/Care Coordinator | 1501 Madison Rd, Walnut Hills, OH 45206-1706 | 2017-12-10 |
| 1003328550 | Kenneth Lee Jackson Jr. | Counselor | 1430 S High St Fl 4, Columbus, OH 43207-1045 | 2017-10-24 |
| 1942674411 | Kenneth David Jackson Jr. | Case Manager/Care Coordinator | 3901 Ulloa St, New Orleans, LA 70119-6942 | 2015-11-21 |
| Street Address |
546 CHIPETA WAY SUITE 220 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84108-1236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326178807 | Tamara A. Dangerfield | Physical Therapist | 546 Chipeta Way, Suite # 220, Salt Lake City, UT 84108-1236 | 2007-03-06 |
| 1750470340 | University of Utah | Durable Medical Equipment & Medical Supplies | 546 Chipeta Way, Salt Lake City, UT 84108-1236 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548753056 | Maxine Ht Erickson | Assistant Behavior Analyst | 780 Guardsman Way, Salt Lake City, Ut 84108, Salt Lake City, USA 84108 | 2018-06-08 |
| 1841704061 | Robyn Carver | Occupational Therapist | 421 Wakara Wat, Salt Lake City, UT 84108 | 2017-11-27 |
| 1518478742 | Lcr Dental Sugar House | Dentist | 2068 S 2100 E Suite #a, Salt Lake City, UT 84108 | 2017-10-16 |
| 1447708912 | Aubrianne Squire Evans | Occupational Therapist | 421 S Wakara Way Ste 201, Salt Lake City, UT 84108 | 2016-09-14 |
| 1629524426 | Ryan Weisenbeck | Specialist/Technologist | 580 S Guardsman Way, Salt Lake City, UT 84108 | 2016-08-31 |
| 1164885547 | Michael Fazzone | Student in an Organized Health Care Education/Training Program | 530 South Wakara Way, University of Urah, School of Dentistry, Salt Lake City, UT 84108 | 2016-04-01 |
| 1669833489 | Bryon Claflin | Registered Nurse | 650 S Komas Ste 200, Salt Lake City, UT 84108 | 2016-03-08 |
| 1801283833 | Autism Assement Treatment Program Adult | Psychologist | 650 S Komas, Suite 200, Salt Lake City, UT 84108 | 2015-04-16 |
| 1578993275 | Matthew and David Dental Pllc | Dentist | 1355 Foothill Drive, Salt Lake City, UT 84108 | 2013-11-15 |
| 1841631520 | Deepika Garg | Internal Medicine | 675 S Arapeen Dr Ste 205, Salt Lake City, UT 84108 | 2013-07-10 |
| Find all providers in zip 84108 | ||||
| Taxonomy Code | 1835P1200X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacotherapy |
| A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing pharmacotherapeutic care of patients, by developing, implementing, monitoring, and modifying complex treatment plans, providing advanced level education and consultation, and collaborating with other health professionals in the management of therapy. |
| Notes: Source: Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447424916 | Jonathan Douglas Hoffman | Pharmacist | George E Wahlen Department of Veterans Ctr, 500 Foothill Drive, Salt Lake City, UT 84148-0001 | 2008-04-16 |
| 1124207493 | Kim Dang | Pharmacist | 50 N Medical Dr Rm A050, Salt Lake City, UT 84132-0001 | 2007-11-02 |
| 1376766279 | Brian Barker | Pharmacist | 50 North Medical Drive (a050), University of Utah Hospital Dept of Pharmacy, Salt Lake City, UT 84123 | 2007-04-10 |
| 1093841272 | Elise Swenson | Pharmacist | 220 S 700 E, Salt Lake City, UT 84102-2106 | 2007-02-24 |
| 1699705558 | Bonnie Kathleen Portley | Pharmacist | Pharmacy Services #119, 500 Foothill Blvd., Salt Lake City, UT 84148-0001 | 2006-07-04 |
| 1801872569 | Jody S. Neuman | Pharmacist | 4543 Zarahemla Dr, Salt Lake City, UT 84124-4039 | 2005-12-15 |
| 1366433559 | Kelly A Kelsey | Pharmacist | 257 E 200 S, Suite 600, Salt Lake City, UT 84111-2048 | 2005-11-04 |
| 1801887757 | Vicky Y. Digregorio | Pharmacist | 555 Foothill Dr, Madsen Health Center, Internal Medicine, Salt Lake City, UT 84112-1106 | 2005-10-31 |
| 1124014626 | Elizabeth Wolcott Young | Pharmacist | 30 S 2000 E, Rm 201, Salt Lake City, UT 84112-5820 | 2005-09-21 |
| 1932105939 | Laura Britton | Pharmacist | 127 S 500 E Ste 160, Salt Lake City, UT 84102-2091 | 2005-06-23 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84108 |
Please comment or provide details below to improve the information on DR. KENNETH CONRAD JACKSON II.
| 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.