Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1255948345 Individual Practitioner Male Practitioner

Dr. Jackson Allen Kicklighter , PharmD, MHA, BCMTMS

Pharmacist • Petersburg, VA

Public Directory Information & Medical Disclaimer

This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.

Professional Overview & Biography Verified Profile Summary

Dr. Jackson Kicklighter, PharmD, MHA, BCMTMS is a registered healthcare professional specializing in Pharmacist in Petersburg, VA. Official NPI practice address is registered at 20 W BANK ST STE 6.

Practice Location & Contact Primary Location

Practice Address

20 W Bank St Ste 6

Petersburg, VA 238033279

Telephone 8048355425
Associated Practice Facility / Clinic
🏢 Genoa Healthcare Llc Facility NPI 1205405206

Specialty Benchmarks & Practice Insights

Comparative analytics for Pharmacist in Petersburg, VA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
45 Specialists

Practicing in Petersburg, VA (6716 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2022-03-14
Pharmacist Primary Specialty

NUCC Taxonomy Code: 183500000X

State License VA 0202219611

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Pharmacist

NUCC Taxonomy Code: 183500000X

State License NC 29807

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Sheila Brown , LPC

Counselor - Professional

NPI 1265944565

Licensed Professional Counselor

Heather Schwartz , LCSW

Social Worker - Clinical

NPI 1295611754

Licensed Clinical Social Worker

Emily Jones , LCSW

Social Worker - Clinical

NPI 1619481843

Licensed Clinical Social Worker

Crystal Solomon , LPC

Counselor - Professional

NPI 1811772254

Licensed Professional Counselor

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
📍
Updated Practice Location October 21, 2022

Registered at 20 W BANK ST STE 6, PETERSBURG, VA 238033279 (Tel: 8048355425)

📍
Updated Business Mailing Address October 21, 2022

Registered at 3424 MIDHURST DR, CHESTER, VA 238311462 (Tel: 7068715549)

👤
Provider Name / Credentials Updated October 21, 2022

Recorded as JACKSON KICKLIGHTER, PHARMD, MHA, BCMTMS

NPI Profile Active September 23, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location September 23, 2020

Registered at 4310 W WENDOVER AVE, GREENSBORO, NC 274071911 (Tel: 3362940335)

📍
Updated Business Mailing Address September 23, 2020

Registered at 3911 WOODBERRY LAKE DR, GREENSBORO, NC 274550945 (Tel: 7068715549)

👤
Provider Name / Credentials Updated September 23, 2020

Recorded as JACKSON KICKLIGHTER, PHARMD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 23, 2020

Pharmacist (License #29807 in NC)

🟢
Initial NPI Registration & Enumeration September 23, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1255948345
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 23, 2020
Last Update: October 21, 2022
Sole Proprietor: No

Mailing Address

3424 Midhurst Dr

Chester, VA 238311462

Phone: 7068715549

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.