Active NPI
Terry Wade Stubblefield, R.PH.
- Pharmacist
- Ecru, MS
National Provider Identifier
1104199934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E7002
- Practice address
- 1065 County Road 228
Ecru, MS 38841 - Phone
- (662) 587-3284
- NPI assigned
- Feb 9, 2012
- 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 | E7002 | MS | Primary |
Addresses
Primary practice location
1065 County Road 228
Ecru, MS 38841
Mailing address
1065 County Road 228
Ecru, MS 38841
Phone (662) 587-3284
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 |
|---|---|---|---|
| E7002 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353974400000",
"number": "1104199934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1065 COUNTY ROAD 228",
"city": "ECRU",
"state": "MS",
"postal_code": "38841",
"telephone_number": "662-587-3284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1065 COUNTY ROAD 228",
"city": "ECRU",
"state": "MS",
"postal_code": "38841",
"telephone_number": "662-587-3284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUBBLEFIELD",
"first_name": "TERRY",
"middle_name": "WADE",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-09",
"last_updated": "2012-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E7002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ecru, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.