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JACKS PHARMACY INC
NPI 1518967710
Pharmacy - Community/Retail Pharmacy in St Maries, ID

Active since July 28, 2005CLIA 13D2183424 · Waiver
103 E COLLEGE AVE, ST MARIES, ID 83861(208) 245-4578(208) 245-5004 Get Directions Write a Review

NPPES record last updated: March 2, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Mar 2, 2026, Feb 7, 2020, Sep 19, 2017 (3 updates tracked since 2017).

About Jacks Pharmacy Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKS PHARMACY INC (NPI 1518967710) is a healthcare organization registered as a community/retail pharmacy in St Maries, Idaho and active in the NPI registry since July 2005. The organization holds a CLIA Waiver certificate valid through May 4, 2028 and lists Benjamin Ralph Potter, Ceo, as its authorized official.

NPPES Registry Identity

NPI1518967710
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameJACKS PHARMACY INC
Location Address103 E COLLEGE AVESt Maries, ID 83861-2247
Mailing Address103 E College AveSt Maries, ID 83861-2247 · (208) 245-4578 · Fax (208) 245-5004
Phone(208) 245-4578
Fax(208) 245-5004
Organization SubpartNo
Authorized OfficialBenjamin Ralph PotterCeo · (208) 719-9095
Enumeration DateJuly 28, 2005
Last NPPES UpdateMarch 2, 20263 updates tracked since enumeration
NPPES CertifiedMarch 2, 2026
✔ NPI 1518967710 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in ID · 1368CP
Definition
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.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
103 E COLLEGE AVE, St Maries, ID 83861
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Other Identifiers 3

Medicaid002494400ID
Medicaid002494500ID
Other1303483ID · Ncpdp

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2183424

Jack's Pharmacy · St Maries, ID
Active · expires May 4, 2028
CLIA Number13D2183424
Laboratory TypePharmacy
Certificate Effective DateMay 5, 2026
Certificate Expiration DateMay 4, 2028
Laboratory DirectorWilliam Yordy
Laboratory Phone(208) 245-4578
Laboratory LocationJack's Pharmacy103 E College Ave, St Maries, ID 83861
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
252 services252 patients
Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
208 services208 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
19 services19 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
19 services19 patients

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEFFREY ALAN BASH PHARM-D
Pharmacist
103 E COLLEGE AVE
ST MARIES, ID 83861
Benewah County (208) 245-4578
DR. BROOK ALLISON KOTLARZ PHARMD
Pharmacist
103 E COLLEGE AVE
ST MARIES, ID 83861
Benewah County (208) 245-4578
DR. DI ANN BUTTERFIELD PHARMD
Pharmacist
103 E COLLEGE AVE
ST MARIES, ID 83861
Benewah County (208) 245-4578
JACKS PHARMACY INC
Durable Medical Equipment & Medical Supplies
103 E COLLEGE AVE
ST MARIES, ID 83861
Benewah County (208) 245-4578

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacks Pharmacy Inc's NPI number?

The NPI number for Jacks Pharmacy Inc is 1518967710. It was assigned to this organization in the NPPES registry on July 28, 2005.

Where is Jacks Pharmacy Inc located?

Jacks Pharmacy Inc is located at 103 E College Ave, St Maries, ID 83861. The listed phone number is (208) 245-4578.

What is Jacks Pharmacy Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Jacks Pharmacy Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2183424) is associated with this NPI, valid through May 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Jacks Pharmacy Inc accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 48 other insurers list Jacks Pharmacy Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jacks Pharmacy Inc was last updated on March 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.