WILLETA LUCKETT (NPI# 1902418072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902418072 |
| Entity Type | Individual |
| Full Name | WILLETA LUCKETT |
| Credential | PHARMD |
| Practice Address |
977 Ellis Ave Jackson MS 39209-6256 |
| Mailing Address |
106 Tracey Cv Madison MS 39110-6045 |
| Practice Telephone | 6019449965 |
| Practice Fax Number | 6019696419 |
| Mailing Telephone | 6019514177 |
| Mailing Fax Number | 6019449965 |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2020-08-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | E-14598 | MS | Pharmacy Service Providers |
| Street Address |
977 ELLIS AVE |
| City | JACKSON |
| State | MS |
| Zip Code | 39209-6256 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649285800 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 977 Ellis Ave, Jackson, MS 39209-6256 | 2006-07-29 |
| 1396350971 | Elena Nicole Hubbard | Pharmacist | 977 Ellis Ave, Jackson, MS 39209-6256 | 2020-09-10 |
| 1407468978 | Angel K Gibson | Pharmacist | 977 Ellis Ave, Jackson, MS 39209-6256 | 2020-08-17 |
| 1902176829 | Karen C. Mcgowan | Pharmacist | 977 Ellis Ave, Jackson, MS 39209-6256 | 2012-01-10 |
| 1053681569 | Ceil D Dixon | Pharmacist | 977 Ellis Ave, Jackson, MS 39209-6256 | 2012-01-01 |
| 1821366279 | Jonethan Michael Morris | Pharmacist | 977 Ellis Ave, Jackson, MS 39209-6256 | 2011-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235754995 | Oak Street Health Physicians Group of Mississippi, LLC | Family Medicine | 911 Ellis Ave, Jackson, MS 39209 | 2020-06-09 |
| 1760003594 | Phi Health, LLC | Ambulance | 582 Ramp Road, Suite C, Jackson, MS 39209 | 2020-05-04 |
| 1720468911 | Genoa Healthcare, LLC | Pharmacy | 3450 Highway 80 W Rm 68, Jackson, MS 39209 | 2015-06-03 |
| 1013302082 | Tiffany Griffin | Nurse Practitioner | 3450 Highway 80 West, Jackson, MS 39209 | 2015-04-06 |
| 1679961957 | Cassetta Shontae Mcgee | Emergency Medical Technician, Basic | 5326 Queen Eleanor Ln, Jackson, MS 39209 | 2015-01-08 |
| 1124381280 | Martin Solution | In Home Supportive Care | 917 West Ridge, Jackson, MS 39209 | 2012-06-22 |
| 1649533589 | Adrinnie M Martin | Contractor | 917 Westridge, Jackson, MS 39209 | 2012-06-15 |
| 1831423862 | Infinity House, Inc | In Home Supportive Care | 1042 Pecan Park Circle, Jackson, MS 39209 | 2009-09-23 |
| 1174751093 | Linda M Vance | Nurse Practitioner | 1000 Metrocenter Ste 105, Jackson, MS 39209 | 2009-06-30 |
| 1770729998 | Kim Hestle | Speech-Language Pathologist | 733 N. Flag Chapel Road, Jackson, MS 39209 | 2008-12-17 |
| Find all providers in zip 39209 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890662 | Angela Shawn Bradley | Pharmacist | 1589 Ky Hwy 15 South, Jackson, KY 41339 | 2020-10-30 |
| 1871191734 | Ranita Greer | Pharmacist | 59 Ky-15 N, Jackson, KY 41339 | 2020-10-13 |
| 1790398287 | Haleema Saadia | Pharmacist | 3144 North Avenue, Jackson, TN 38305-0100 | 2020-08-25 |
| 1821600578 | Maame Obeng | Pharmacist | 3144 North Highland Avenue, Jackson, TN 38305 | 2020-08-22 |
| 1124645965 | Archis B Patel | Pharmacist | 6 Moet Ct, Jackson, NJ 08527-3090 | 2020-06-27 |
| 1417579798 | Alvin Ray Stewart Sr. | Pharmacist | 696 Cedar Springs Dr, Jackson, MS 39212-5710 | 2020-05-10 |
| 1033731492 | Jamie Hines Mckinley | Pharmacist | 1500 E Woodrow Wilson Ave Dept 119-a, Jackson, MS 39216-5116 | 2020-05-08 |
| 1356980643 | Bethany Powers | Pharmacist | 4910 Interstate 55 North Frontage Rd, Jackson, MS 39211 | 2020-01-03 |
| 1770130650 | Elizabeth Hearn | Pharmacist | 1345 Simwood Pl, Jackson, MS 39211-6352 | 2019-08-24 |
| 1306493929 | Stephen Benjamin Porter | Pharmacist | 350 W Woodrow Wilson Ave Rm Me101-42, Jackson, MS 39213-7681 | 2019-08-19 |
| 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.