DR. KEITH WESLEY JACKSON (NPI# 1952890030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952890030 |
| Entity Type | Individual |
| Full Name | DR. KEITH WESLEY JACKSON |
| Credential | PHARMD |
| Practice Address |
1900 Carew St Ste 4 Fort Wayne IN 46805-4765 |
| Practice Telephone | 2603739775 |
| Mailing Telephone | 2603739775 |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-05-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 26019319A | IN | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407491673 | Keith Jackson | Home Health | 2934 Pelzer Ave, Montgomery, AL 36109-2147 | 2019-11-12 |
| 1871935569 | Keith Daniel Jackson | Dentist | 10868 Us Highway 15 501, Southern Pines, NC 28387-5149 | 2013-07-23 |
| 1720263031 | Keith Edward Jackson | Nurse Practitioner | 11114 Endicott Ln, Houston, TX 77035-3007 | 2008-01-04 |
| 1205866142 | Keith E Jackson | Nurse Anesthetist, Certified Registered | 100 Rice Mine Rd N, Tuscaloosa, AL 35406-2300 | 2006-07-04 |
| 1225016454 | Keith Jackson | Otolaryngology | 1360 Upper Hembree Rd Ste 201b, Roswell, GA 30076-1230 | 2006-01-06 |
| 1184278129 | Keith T. Jackson | Physical Therapist | 4000 Johnson Rd, Steubenville, OH 43952-2364 | 2019-07-29 |
| 1326527045 | Keith Allen Jackson | Physician Assistant | 3000 Q St Fl 4, Sacramento, CA 95816-7058 | 2018-08-13 |
| 1457837551 | Keith Jackson | Case Manager/Care Coordinator | 1430 Olive St Ste 400, Saint Louis, MO 63103-2303 | 2018-07-12 |
| 1033557228 | Keith L Jackson | Rehabilitation Practitioner | 7381 Prairie Falcon Rd, Las Vegas, NV 89128-0811 | 2013-06-10 |
| 1033461280 | Keith Darnell Jackson | Social Worker | 7550 Constantinople Ave, Las Vegas, NV 89129-6505 | 2012-10-12 |
| Street Address |
1900 CAREW ST STE 4 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-4765 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063900611 | Juliette Peters | Pharmacist | 1900 Carew St Ste 4, Fort Wayne, IN 46805-4765 | 2018-04-30 |
| 1831688100 | Marylou Cecelia Mettler | Pharmacist | 1900 Carew St Ste 4, Fort Wayne, IN 46805-4765 | 2018-05-02 |
| 1174011720 | Benjamin Schortgen | Pharmacist | 1900 Carew St Ste 4, Fort Wayne, IN 46805-4765 | 2018-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| 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 |
|---|---|---|---|---|
| 1295347102 | Austin Hartzog | Pharmacist | 5110 Value Drive, Fort Wayne, IN 46808 | 2020-08-21 |
| 1528677622 | Leslie Renee Siegel | Pharmacist | 11109 Parkview Plaza Dr # 1, Fort Wayne, IN 46845-1701 | 2020-07-24 |
| 1962048140 | Andrew Quang Tran | Pharmacist | 6202 Saint Joe Center Rd, Fort Wayne, IN 46835-2506 | 2019-11-21 |
| 1467005991 | Nicholas Selby | Pharmacist | 6220 Saint Joe Center Rd, Fort Wayne, IN 46835-2506 | 2019-07-23 |
| 1215427042 | Jerry Eugene Falls | Pharmacist | 9817 Chapmans Blvd, Fort Wayne, IN 46835-9194 | 2018-05-17 |
| 1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
| 1063900611 | Juliette Peters | Pharmacist | 1900 Carew St Ste 4, Fort Wayne, IN 46805-4765 | 2018-04-30 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1790238350 | Karleen Goodwin | Pharmacist | 3964 New Vision Dr, Fort Wayne, IN 46845-1712 | 2016-08-01 |
| 1699131300 | Brent Alan Losier | Pharmacist | 3537 N Anthony Blvd, Suite A, Fort Wayne, IN 46805-1423 | 2016-01-11 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on DR. KEITH WESLEY JACKSON.
| 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.