Active NPI
Derek White, PHARMD
- Pharmacist
- Fordyce, AR
National Provider Identifier
1063013365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD09249
- Practice address
- Walmart Pharmacy
1123 Highway 79-167 Bypass
Fordyce, AR 71742 - Phone
- (870) 352-8034
- Fax
- (870) 352-8337
- NPI assigned
- Nov 3, 2020
- Sex
- Male
- Sole proprietor
- No
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 | PD09249 | AR | Primary |
Addresses
Primary practice location
Walmart Pharmacy
1123 Highway 79-167 Bypass
Fordyce, AR 71742
Mailing address
Walmart Pharmacy
1123 Highway 79-167 Bypass
Fordyce, AR 71742
Phone (870) 352-8034
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
| License | State | Type | Specialty |
|---|---|---|---|
| PD09249 | AR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604361600000",
"number": "1063013365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "WALMART PHARMACY",
"address_2": "1123 HIGHWAY 79-167 BYPASS",
"city": "FORDYCE",
"state": "AR",
"postal_code": "71742",
"telephone_number": "870-352-8034",
"fax_number": "870-352-8337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "WALMART PHARMACY",
"address_2": "1123 HIGHWAY 79-167 BYPASS",
"city": "FORDYCE",
"state": "AR",
"postal_code": "71742",
"telephone_number": "870-352-8034",
"fax_number": "870-352-8337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "DEREK",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-03",
"last_updated": "2020-11-03",
"certification_date": "2020-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD09249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fordyce, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.