JACKS PHARMACY INC
NPI 1619001187
Durable Medical Equipment & Medical Supplies in St Maries, ID
NPI Status: Active since March 15, 2007
Contact Information
103 E COLLEGE AVE
ST MARIES, ID
ZIP 83861
Phone: (208) 245-4578
Fax: (208) 245-5004
- Organization
- Durable Medical Equipment & Medical Supp...
- Medicare Supplier
- Accepts Medicare Approved Payment
- CLIA Number: 13D2183424
- CLIA Cert. Type: Pharmacy
- CLIA Exp. Date: 05-04-2028
About JACKS PHARMACY INC
This page provides the complete NPI Profile along with additional information for Jacks Pharmacy Inc, a provider established in St Maries, Idaho operating as a Durable Medical Equipment & Medical Supplies. The healthcare provider is registered in the NPI registry with number 1619001187 assigned on March 2007. The practitioner's primary taxonomy code is 332B00000X with license number 1368CP (ID). The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Dr. Colt Darley Pharmd (Pharmacist/president)
- NPI
- 1619001187
- Provider Name
- JACKS PHARMACY INC
- Entity Type
- Organization
- Location Address
- 103 E COLLEGE AVE ST MARIES, ID 83861
- Location Phone
- (208) 245-4578
- Location Fax
- (208) 245-5004
- Mailing Address
- 103 E COLLEGE AVE ST MARIES, ID 83861
- Mailing Phone
- (208) 245-4578
- Mailing Fax
- (208) 245-5004
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-15-2007
- Last Update Date
- 04-23-2025
- Code Navigator
Jacks Pharmacy Inc is a medicare supplier with PTAN 34357946 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Immunosuppressive Drugs or Nebulizer Drugs or Commodes, Urinals, Bedpans or Blood Glucose Monitors/Supplies (Non-Mail Order) or Heat & Cold Applications or Canes and/or Crutches or Nebulizer Equipment and/or Supplies or Surgical Dressings.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Durable Medical Equipment & Medical Supplies
- Taxonomy Code
- 332B00000X
- Type
- Suppliers
- License No.
- 1368CP
- License State
- ID
- Taxonomy Description
- A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 3336C0003X | Suppliers | Pharmacy |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1303483 | OTHER (01) | ID | NCPDP |
| 002494500 | MEDICAID (05) | ID | |
| 002494400 | MEDICAID (05) | ID |
Medical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 34357946
- Accepts Medicare Assignment
- YES
- Specialities List
- Pharmacy.
- Competitive Bidding
- NO
Supplies List
- Immunosuppressive Drugs - Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
- Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
- Commodes, Urinals, Bedpans - Raised toilets, Drop-arm commodes, Folding commodes, Plastic urinals, Plastic bedpans, Disposable urinals
- Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
- Heat & Cold Applications - Heat therapy, Cold therapy, Heating pads
- Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
- Nebulizer Equipment and/or Supplies - Nebulizers, Atomizers, Filters
- Surgical Dressings - Gauze, Elastic bandages, Adhesive tape
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 this NPI number is:
- CLIA Number
- 13D2183424
- Facility Type
- Pharmacy
- Certificate Effective Date
- May 05, 2026
- Certificate Expiration Date
- May 04, 2028
- Laboratory Director
- COLT T. DARLEY PHARMD
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Jacks Pharmacy Inc 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.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1619001187, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 4 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1619001187, enumerated as an "organization" on March 15, 2007.
The provider is located at 103 E COLLEGE AVE ST MARIES, ID 83861 and the phone number is (208) 245-4578.
Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
