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JACKSON DRUGS LLC NPI 1124161435


NPI Information

NPI: 1124161435
Provider Name: JACKSON DRUGS, LLC
Classification: Clinic/Center - 261QD1600X
Entity Type: Organization

Specialization: Developmental Disabilities

CLIA Number: 10D2240008

Address:
2301 OKEECHOBEE RD
FORT PIERCE, FL
ZIP 34950
Phone: (772) 464-3784
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JACKSON DRUGS, LLC is a developmental disabilities clinic center in Fort Pierce, FL. The provider is an entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). JACKSON DRUGS, LLC NPI is 1124161435. The provider is registered as an organization entity type.

The provider's business location address is:

2301 OKEECHOBEE RD
FORT PIERCE, FL
ZIP 34950-554
Phone: (772) 464-3784
Fax: (772) 467-9153

The provider's authorized official is Akash Ramlagan .
The authorized official title is Owner and has the following contact phone number (772) 464-3784.

The CLIA number assigned to this NPI record is 10D2240008 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/15/2007 and was last updated on 9/9/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0003XPharmacyCommunity/Retail PharmacyPH6577FLORIDANo
2261QD1600XClinic/CenterDevelopmental DisabilitiesYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1103687400MEDICAIDFLORIDA
2110883600MEDICAIDFLORIDA
31032250OTHERFLORIDAPHARMACY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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