Jacks Pharmacy Inc
Jacks Pharmacy Inc is a healthcare organization registered as Durable Medical Equipment & Medical Supplies in St Maries, ID, holding Type 2 (organization) NPI 1619001187 since 2007. The authorized official on file is Colt Darley, Pharmacist/President.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1619001187 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Jacks Pharmacy Inc |
| Practice address | 103 E COLLEGE AVE, St Maries, ID, 83861 |
| Phone | 2082454578 |
| Fax | 2082455004 |
| Enumeration date | 2007-03-15 |
| Last updated in NPPES | 2025-04-23 |
Authorized official
| Name | Colt Darley |
|---|---|
| Title | Pharmacist/President |
| Phone | 2082454578 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 3336C0003X | Community/Retail Pharmacy | Secondary | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | Primary | 1368CP | ID |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1303483 | Other | ID | NCPDP |
| 002494500 | Medicaid | ID | — |
| 002494400 | Medicaid | ID | — |
Copy-ready billing details
Provider: Jacks Pharmacy Inc NPI: 1619001187 Taxonomy: 332B00000X (Durable Medical Equipment & Medical Supplies) Address: 103 E COLLEGE AVE, St Maries, ID, 83861
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1518967710 | Jacks Pharmacy Inc | Organization | Community/Retail Pharmacy | St Maries, ID |
| 1396225827 | Di Ann Butterfield | Individual | Pharmacist | St Maries, ID |
| 1023617883 | Jeffrey Bash | Individual | Pharmacist | St Maries, ID |
| 1124718051 | Brook Kotlarz | Individual | Pharmacist | St Maries, ID |
Verify this record
Cross-check NPI 1619001187 against the authoritative CMS record: view Jacks Pharmacy Inc on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What type of organization is Jacks Pharmacy Inc?
What is a Type 2 NPI?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2025-04-23.