STATE VETERANS AFFAIRS BOARD (NPI# 1962999789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962999789 |
| Entity Type | Organization |
| Organization Name | STATE VETERANS AFFAIRS BOARD |
| Practice Address |
4607 Lindbergh Dr Jackson MS 39209-3855 |
| Practice Telephone | 6013536142 |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2018-04-17 |
| Authorized Official Name | CARLOS BLACK (PHARMACIST) |
| Authorized Official Telephone | 6628033858 |
| Authorized Official Credential | PHARM.D |
| Is Organization Subpart | Y |
| Parent Organization Name | STATE VETERANS AFFAIRS BOARD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982811642 | State Veterans Affairs Board | Skilled Nursing Facility | 3466 Highway 80 E, Pearl, MS 39208-4001 | 2007-05-16 |
| Street Address |
4607 LINDBERGH DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39209-3855 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700037363 | Angela Nelson | Occupational Therapy Assistant | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2008-10-01 |
| 1013484567 | Donna Saxton Harris | Occupational Therapist | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2018-11-01 |
| 1922504661 | Lauren Ashley Stuart | Physical Therapy Assistant | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2018-04-02 |
| 1740785864 | Candace Leigh Mcfarland | Physical Therapy Assistant | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2018-03-29 |
| 1962901785 | Jessica Whitehead | Physical Therapy Assistant | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2018-02-07 |
| 1447774617 | Abbie Joiner | Physical Medicine & Rehabilitation | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2017-07-31 |
| 1720508096 | Emma Corinne Hotard | Speech-Language Pathologist | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2017-06-27 |
| 1528431434 | Amy Tucker | Physical Therapist | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2015-11-02 |
| 1881016145 | Julia Kowalski | Physical Therapy Assistant | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2014-01-06 |
| 1710328901 | Melanie Holliday | Occupational Therapy Assistant | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2013-07-16 |
| Find all providers in the same location | ||||
| 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 | 3336I0012X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Institutional Pharmacy |
| A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; 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 |
|---|---|---|---|---|
| 1689165482 | Georgia Diagnostic & Classification Prison Pharmacy | Pharmacy | 2978 Highway 36 W, Jackson, GA 30233-6150 | 2018-05-29 |
| 1811039704 | Jackson-madison County General Hospital | Pharmacy | 708 W Forest Ave, Jackson, TN 38301-3901 | 2007-02-14 |
| 1003979386 | St. Dominic-jackson Memorial Hospital | Pharmacy | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2006-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104998269 | Pharmakan, Inc | Pharmacy | 1042a River Oaks Dr, Flowood, MS 39232-9594 | 2006-11-14 |
| 1558372193 | Diamond Grove Ctr Pharmacy | Pharmacy | 2311 Highway 15 S, Louisville, MS 39339-7071 | 2006-08-10 |
| 1740202571 | Boswell Regional Center | Pharmacy | 1049 Hwy 149, Magee, MS 39111 | 2006-07-24 |
| 1023549060 | Brentwood Acquisition Pharmacy | Pharmacy | 3531 Lakeland Dr, Flowood, MS 39232-8049 | 2017-03-22 |
| 1285177394 | Formulaone Pharmaceuticals, LLC | Pharmacy | 127 Pratt Dr, Corinth, MS 38834-6026 | 2016-11-21 |
| 1578989430 | King's Daughters Hospital Pharmacy | Pharmacy | 823 Grand Ave, Yazoo City, MS 39194-3233 | 2014-03-14 |
| 1841623808 | George County Pharmacy | Pharmacy | 92 Ratliff St, Lucedale, MS 39452-6537 | 2013-08-14 |
| 1487787347 | Alliance Health Center Pharmacy | Pharmacy | 5000 Highway 39 N, Meridian, MS 39301-1021 | 2007-03-13 |
| 1619000593 | Diamond Grove Center | Pharmacy | 2311 Highway 15 S, Louisville, MS 39339-7071 | 2007-03-13 |
| 1194850917 | North Mississippi State Hospital Pharmacy | Pharmacy | 1937 Briar Ridge Rd, Tupelo, MS 38804-5963 | 2007-02-22 |
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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.