Waltmoor Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

007132 Issued in KY

Legal business name

WALTMOOR CORP

Practice address

3603 Cumberland Ave
Middlesboro, KY 40965-2613

Phone

(606) 248-8900

Fax

(606) 248-8901

NPI assigned

Jan 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Trent Walters

Title

Owner

Phone

(606) 248-8900

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• WALTERS PHARMACY SHOPPE Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeremiah Hilton Brooks III, M.D.

  • Internal Medicine Physician
  • Middlesboro, KY
  • NPI 1154315075
  NPD (past)
• Robert Scott Marcum, PHARM-D

  • Pharmacist
  • Middlesboro, KY
  • NPI 1275140840
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270080000000",
    "number": "1154479152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3603 CUMBERLAND AVE",
            "address_2": "PO BOX 07",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3603 CUMBERLAND AVE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652613",
            "telephone_number": "606-248-8900",
            "fax_number": "606-248-8901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTMOOR CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2010-04-01",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "TRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-248-8900"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "007132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1813787",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1813787",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54017041",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALTERS PHARMACY SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Veillon, OTR/L
• Bethany Lauren Wade
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• April Wallace
• Angela Warren
• Andrew Stephen Weaver Jr., PHARMD
• Kali Stickley Weaver, PHARM.D.
• Patrick Wedolowski, CRNA
• Karen Marie Whittaker-Murphy, OTR/L, CEAS II

• Community/Retail Pharmacy in Middlesboro, KY
• Providers in Middlesboro, KY by specialty
• Community/Retail Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.

Verify at the official NPI Registry.