Individual provider Active NPI

Andy Steven Willis, PHARM.D.

  • Pharmacist
  • Forest City, NC
National Provider Identifier
1043695505
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
25119 Issued in NC
Practice address
139 E Main St
Forest City, NC 28043-3125
Phone
(828) 245-4591
Fax
(828) 245-3273
NPI assigned
Jul 27, 2015
Last updated
Jul 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 25119 NC Primary

Addresses

Primary practice location

139 E Main St
Forest City, NC 28043-3125

Mailing address

139 E Main St Ste B
Forest City, NC 28043-3125
Phone (828) 245-5126

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
25119NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Smiths Drugs of Forest City PastSince Jul 21, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1043695505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 E MAIN ST STE B",
            "city": "FOREST CITY",
            "state": "NC",
            "postal_code": "280433125",
            "telephone_number": "828-245-5126",
            "fax_number": "828-245-5013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 E MAIN ST",
            "city": "FOREST CITY",
            "state": "NC",
            "postal_code": "280433125",
            "telephone_number": "828-245-4591",
            "fax_number": "828-245-3273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "ANDY",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-27",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "25119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.