MT JACKSON DRUG STORE INC (NPI# 1346322120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346322120 |
| Entity Type | Organization |
| Organization Name | MT JACKSON DRUG STORE INC |
| Other Organization Name | MT JACKSON DRUG STORE |
| Practice Address |
5350 Main St Mount Jackson VA 22842-9511 |
| Mailing Address |
Po Box 473 Mount Jackson VA 22842-0473 |
| Practice Telephone | 5404773101 |
| Practice Fax Number | 5404774039 |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-08-16 |
| Authorized Official Name | JAMES FANSLER (PRESIDENT OWNER) |
| Authorized Official Telephone | 5404773101 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
0201002587 | VA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 010078059 | 05 | |
| PK | 2102235 | 01 |
| Other Name | Type Code |
|---|---|
| MT JACKSON DRUG STORE | Doing Business As Name - Organization |
| Street Address |
5350 MAIN ST |
| City | MOUNT JACKSON |
| State | VA |
| Zip Code | 22842-9511 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770026478 | Dkkp Inc | Pharmacy | 5350 Main St, Mount Jackson, VA 22842-9511 | 2016-11-29 |
| 1366515447 | Robert E. Willey | Pharmacist | 5350 Main St, Mount Jackson, VA 22842-9511 | 2006-11-16 |
| 1073683306 | Larry L Fuchs | Pharmacist | 5350 Main St, Mount Jackson, VA 22842-9511 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538619473 | Skyler Tyne Sharp | Nurse Practitioner | 5173 South Main Street, Mt Jackson, VA 22842 | 2016-10-04 |
| 1427109628 | Sharon Sammons Clark | Dietitian, Registered | 8006 Senedo Rd, Mount Jackson, VA 22842-2232 | 2007-01-15 |
| 1497994172 | North Mountain Dietetic Services, LLC | Dietitian, Registered | 8006 Senedo Rd, Mount Jackson, VA 22842-2232 | 2009-02-19 |
| 1952848418 | Assisting Angels Home Care LLC | Home Health | 14274 Senedo Rd, Mount Jackson, VA 22842-2408 | 2017-01-23 |
| 1205072519 | Warren A Wittig | Technician/Technologist | 215 Conicville Blvd, Mount Jackson, VA 22842-2862 | 2008-12-17 |
| 1609300870 | Simeon A Melaku | Family Medicine | 120 Medical Dr, Mount Jackson, VA 22842-9417 | 2017-04-14 |
| 1649531401 | Jason Asistores | Family Medicine | 120 Medical Dr, Mount Jackson, VA 22842-9417 | 2012-06-07 |
| 1144467796 | Ruth N. Holmaas | Nurse Practitioner | 120 Medical Dr, Mount Jackson, VA 22842-9417 | 2009-01-18 |
| 1831153121 | Nancy L. Brubaker | Nurse Practitioner | 120 Medical Dr, Mount Jackson, VA 22842-9417 | 2006-04-13 |
| 1649234048 | Janet L Polansky | Family Medicine | 120 Medical Dr, Mount Jackson, VA 22842-9417 | 2006-04-13 |
| Find all providers in zip 22842 | ||||
| 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] |
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|---|---|---|---|---|
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| 1275156572 | Herbert T Nguyen | Pharmacy | 5100 Harford Ln, Burke, VA 22015-1510 | 2020-05-20 |
| 1932720174 | Warrington Wellness and Compounding Pharmacy | Pharmacy | 805 Kent Pl Ste 104, Chesapeake, VA 23320-0768 | 2020-04-28 |
| 1467081273 | Chungkang Pharmacy, LLC | Pharmacy | 14637 Lee Hwy # 109b, Centreville, VA 20121-5829 | 2020-04-03 |
| 1174151716 | Vandorn Apothecary LLC | Pharmacy | 5724 Edsall Rd Alexandria Va 22304, Alexandria, VA 22304-4712 | 2020-03-30 |
| 1528691946 | Pharmacy One LLC | Pharmacy | 14904 Jefferson Davis Hwy Ste 101, Woodbridge, VA 22191-3908 | 2020-02-13 |
| 1477193936 | Anderson & Payne Pharmacy Inc | Pharmacy | 16 Gosnell Xing Ste 101, Staunton, VA 24401-6344 | 2020-01-13 |
| 1245876531 | Farmville Family Pharmacy, Inc. | Pharmacy | 1538 South Main Street, Farmville, VA 23901 | 2019-11-21 |
| 1215578901 | Jtj Medical Supply, Inc. | Pharmacy | 1001 Monticello Ave, Norfolk, VA 23510-2564 | 2019-10-03 |
| 1659912889 | Aylin Unal | Pharmacy | 1409 Emmet St N, Charlottesville, VA 22903-4874 | 2019-09-29 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT JACKSON |
| Zip Code | 22842 |
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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.