Active NPI
Phil H Waltz Jr., RPH
- Pharmacist
- Ruston, LA
National Provider Identifier
1083942759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9728
- Practice address
- 200 N Trenton St
Ruston, LA 71270-4324 - Phone
- (318) 255-0458
- Fax
- (318) 251-3373
- NPI assigned
- Nov 18, 2009
- Last updated
- Nov 18, 2009
- 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 | 9728 | LA | Primary |
Addresses
Primary practice location
200 N Trenton St
Ruston, LA 71270-4324
Mailing address
2102 Knowles Dr
Ruston, LA 71270-2619
Phone (318) 255-0659
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9728 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Waltz & Brazzel Pharmacy Inc | Current | Accepting new patients |
Locations
200 N Trenton St
Ruston, LA 71270
Phone (318) 224-2840
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": "1258502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258502400000",
"number": "1083942759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2102 KNOWLES DR",
"city": "RUSTON",
"state": "LA",
"postal_code": "712702619",
"telephone_number": "318-255-0659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N TRENTON ST",
"city": "RUSTON",
"state": "LA",
"postal_code": "712704324",
"telephone_number": "318-255-0458",
"fax_number": "318-251-3373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTZ",
"first_name": "PHIL",
"middle_name": "H",
"name_suffix": "Jr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-11-18",
"last_updated": "2009-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "9728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ruston, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.