Individual provider Active NPI

Walter Putnam, PHARM D

  • Pharmacist
  • Tucson, AZ
National Provider Identifier
1164879482
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
S021981 Issued in AZ
Practice address
1021 E Palmdale St Ste 150-P
Tucson, AZ 85714-1857
Phone
(520) 399-8279
NPI assigned
May 17, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X S021981 AZ Primary

Addresses

Primary practice location

1021 E Palmdale St Ste 150-P
Tucson, AZ 85714-1857

Mailing address

1460 N Dorado Blvd
Tucson, AZ 85715-4708
Phone (520) 390-3944

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
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
S021981AZMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Genoa Healthcare LLC CurrentSince Mar 13, 2022 Accepting new patients
Genoa Healthcare LLC PastSince Mar 13, 2022 Accepting new patients

Locations

1021 E Palmdale St
Ste 150P
Tucson, AZ 85714
Phone (520) 399-8279

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.

NPI Registry JSON

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

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1164879482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 N DORADO BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857154708",
            "telephone_number": "520-390-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 E PALMDALE ST STE 150-P",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857141857",
            "telephone_number": "520-399-8279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTNAM",
        "first_name": "WALTER",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-17",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S021981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; 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.