Active NPI
Jacob Matlock
- Pharmacist
- Fort Smith, AR
National Provider Identifier
1013518877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD11121
- Practice address
- 2425 S Zero St
Fort Smith, AR 72901-8663 - Phone
- (479) 646-4983
- NPI assigned
- Nov 6, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD11121 | AR | Primary |
Addresses
Primary practice location
2425 S Zero St
Fort Smith, AR 72901-8663
Mailing address
479745 E 1100 Rd
Roland, OK 74954-5069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD11121 | AR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604620800000",
"number": "1013518877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "479745 E 1100 RD",
"city": "ROLAND",
"state": "OK",
"postal_code": "749545069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 S ZERO ST",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729018663",
"telephone_number": "479-646-4983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATLOCK",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-06",
"last_updated": "2020-11-06",
"certification_date": "2020-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD11121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.