Active NPI
Jerry W Waymire, DPH,PD
- Pharmacist
- Poteau, OK
National Provider Identifier
1124344700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9314
- Practice address
- 2219 N Broadway St
Poteau, OK 74953-2007 - Phone
- (918) 647-9531
- Fax
- (918) 647-5247
- NPI assigned
- Apr 8, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9314 | OK | Primary |
| Pharmacist | 183500000X | 6548 | AR |
Addresses
Primary practice location
2219 N Broadway St
Poteau, OK 74953-2007
Mailing address
2219 N Broadway Ave
Poteau, OK 74953
Phone (918) 647-9531
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6548 | AR | MD | Pharmacist |
| 9314 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270684800000",
"number": "1124344700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2219 N BROADWAY AVE",
"city": "POTEAU",
"state": "OK",
"postal_code": "74953",
"telephone_number": "918-647-9531",
"fax_number": "918-647-5247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2219 N BROADWAY ST",
"city": "POTEAU",
"state": "OK",
"postal_code": "749532007",
"telephone_number": "918-647-9531",
"fax_number": "918-647-5247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAYMIRE",
"first_name": "JERRY",
"middle_name": "W",
"credential": "DPH,PD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-08",
"last_updated": "2010-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "9314",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "6548",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poteau, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.