NORTH JACKSON PHARMACY (KILGORE EXPRESS PHARMACY INC) NPI 1497769491

Pharmacy (Community/Retail Pharmacy) in Stevenson, AL

Organization Pharmacy Community/Retail Pharmacy Medicare Supplier CLIA Number 01D2195533 CLIA Certificate of Waiver

About NORTH JACKSON PHARMACY (KILGORE EXPRESS PHARMACY INC)

North Jackson Pharmacy (kilgore Express Pharmacy Inc) is a provider established in Stevenson, Alabama specializing in pharmacy (community/retail pharmacy) . The NPI number of North Jackson Pharmacy (kilgore Express Pharmacy Inc) is 1497769491 and was assigned on July 2006. The practitioner's primary taxonomy code is 3336C0003X with license number 107218 (AL). The provider is registered as an organization and their NPI record was last updated one year ago. The provider's is doing business as North Jackson Pharmacy. The authorized official of this NPI record is Lotha Lee Kilgore (Owner)

The provider accepts Medicare assignment for all durable medical equipment and supplies. North Jackson Pharmacy carries the following product categories: home blood glucose monitors, test strips, lancets, raised toilets, drop-arm commodes, folding commodes, plastic urinals, plastic bedpans, disposable urinals, custom fabricated shoes, socks, & insoles, shoes, socks, insoles, disposable insulin delivery system, mechanical insulin infusion pumps, needle type infusion sets, cannula type infusion sets, etc

The CLIA number of North Jackson Pharmacy is 01D2195533 registered as a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to North Jackson Pharmacy to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1497769491

Provider NameNORTH JACKSON PHARMACY (KILGORE EXPRESS PHARMACY INC)
Provider Location Address85 BANK ST STEVENSON, AL 35772
Provider Mailing AddressPO BOX 680905 FORT PAYNE, AL 35968
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameNORTH JACKSON PHARMACY
Other Name TypeDoing Business As (3)
Enumeration Date07-28-2006
Last Update Date12-31-2019

Primary Taxonomy

Taxonomy Code3336C0003X
ClassificationPharmacy
TypeSuppliers
SpecializationCommunity/Retail Pharmacy
License No.107218
License StateAL
Taxonomy DescriptionA 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.

Business Address

NORTH JACKSON PHARMACY
85 BANK ST
STEVENSON, AL
ZIP 35772
Phone: (256) 437-2248
Fax: (256) 437-9003

Get Directions

Mailing Address

NORTH JACKSON PHARMACY
PO BOX 680905
FORT PAYNE, AL
ZIP 35968
Phone: (256) 437-2248
Fax: (256) 437-9003

Authorized Official

Authorized Official Name LOTHA LEE KILGORE
Authorized Official TitleOWNER
Authorized Official Phone(256) 845-6640

Medicare - Medical Supplier Products

The provider accepts medicare and carries the following medical supplies product categories:

  • Blood Glucose Monitors & Supplies: Non-Mail Order - Home blood glucose monitors, Test strips, Lancets
  • Commodes, Urinals, & Bedpans - Raised toilets, Drop-arm commodes, Folding commodes, Plastic urinals, Plastic bedpans, Disposable urinals
  • Diabetic Shoes & Inserts: Custom Fabricated - Custom fabricated shoes, socks, & insoles
  • Diabetic Shoes & Inserts: Prefabricated - Shoes, Socks, Insoles
  • Infusion Pumps & Supplies: Insulin Infusion - Disposable Insulin Delivery System, Mechanical insulin infusion pumps, Needle type infusion sets, Cannula type infusion sets
  • Orthoses: Off-the-Shelf - Met pads, Heel pads, Heel spur pads
  • Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
  • Urological Supplies - Catheters, Urinary collection devices

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1497769491 is:

CLIA Number01D2195533
Facility TypePHARMACY
Certificate TypeCertificate of Waiver

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
1992953OTHER (01)
100002584MEDICAID (05)AL

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1407043011MR. JAMES AULTON PARKER RPH
Individual
Pharmacist85 BANK ST
STEVENSON, AL 35772
(256) 437-2248

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.