Active NPI
Kristie L Meacheam Wallace, RPH
- Pharmacist
- Ozark, MO
National Provider Identifier
1093098063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 044157
- Practice address
- 2004 W Marler LN
Ozark, MO 65721-7661 - Phone
- (417) 581-3288
- NPI assigned
- Sep 26, 2011
- Sex
- Female
- 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 | 044157 | MO | Primary |
Addresses
Primary practice location
2004 W Marler LN
Ozark, MO 65721-7661
Mailing address
1039 E Maryland CT
Springfield, MO 65810-2982
Phone (417) 890-7093
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 |
|---|---|---|---|
| 044157 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri LTC Pharmacy LLC | Current | Accepting new patients | |
| Missouri LTC Pharmacy LLC | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Long Term Care Pharmacy
- Brookline, MO
- NPI 1003327537
-
- Long Term Care Pharmacy
- Fenton, MO
- NPI 1134668445
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482364800000",
"number": "1093098063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1039 E MARYLAND CT",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658102982",
"telephone_number": "417-890-7093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2004 W MARLER LN",
"city": "OZARK",
"state": "MO",
"postal_code": "657217661",
"telephone_number": "417-581-3288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEACHEAM WALLACE",
"first_name": "KRISTIE",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-26",
"last_updated": "2016-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "044157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ozark, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.