JACKS PHARMACY INC NPI 1518967710

NPI Information

  • NPI: 1518967710
  • Provider Name: JACKS PHARMACY INC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • CLIA Number: 13D2183424
  • Address: 103 E COLLEGE AVE
    ST MARIES, ID
    ZIP 83861
  • Phone: (208) 245-4578

Map and Directions

Get Directions

NPI Details

JACKS PHARMACY INC is a community/retail pharmacy pharmacy in St Maries, ID. The provider is 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. JACKS PHARMACY INC NPI is 1518967710. The provider is registered as an organization entity type.

The provider's business location address is:

103 E COLLEGE AVE
ST MARIES, ID
ZIP 83861-247
Phone: (208) 245-4578
Fax: (208) 245-5004

The provider's authorized official is Colt Darley .
The authorized official title is Pharmacist/president and has the following contact phone number (208) 245-4578.

The CLIA number assigned to this NPI record is 13D2183424 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
  • Fee covid-19 vac 14 res (HCPCS:0134A)
  • Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage (HCPCS:90686)
  • Administration of pneumococcal vaccine (HCPCS:G0009)

The enumeration date for this NPI number is 7/28/2005 and was last updated on 2/7/2020.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336C0003XPharmacyCommunity/Retail Pharmacy1368CPIDAHOYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1002494500MEDICAIDIDAHO
2002494400MEDICAIDIDAHO
31303483OTHERIDAHONCPDP

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: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI