Wilson Bearden Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR10895 Issued in AR

Legal business name

WILSON BEARDEN PHARMACY INC

Doing business as

WILSON BEARDEN PHARMACY

Practice address

134 N Washington
Magnolia, AR 71753-2856

Phone

(870) 234-1062

Fax

(870) 234-8366

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Ivy Moore, PDNPI 1194943225

Title

Pharmacist and Owner

Phone

(870) 234-1062

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• WILSON BEARDEN PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 1

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

• Ivy D Moore, PD

  • Pharmacist
  • Magnolia, AR
  • NPI 1194943225
  NPD Authorized official

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460419200000",
    "number": "1174534705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 597",
            "city": "MAGNOLIA",
            "state": "AR",
            "postal_code": "717540597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 N WASHINGTON",
            "city": "MAGNOLIA",
            "state": "AR",
            "postal_code": "717532856",
            "telephone_number": "870-234-1062",
            "fax_number": "870-234-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON BEARDEN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2016-04-12",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "IVY",
        "authorized_official_title_or_position": "PHARMACIST AND OWNER",
        "authorized_official_telephone_number": "870-234-1062",
        "authorized_official_credential": "PD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR10895",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1994116",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210631407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILSON BEARDEN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cecelia Willis
• Christopher M Willis, PTA
• Jamie Willis
• Latrina Willis, LPC
• Wilson Bearden Pharmacy Inc
• Terries Wilson
• Shuron Witcher
• Corban Wood
• Dylan Wood
• Madison Reed Woodard, RN

• Community/Retail Pharmacy in Magnolia, AR
• Providers in Magnolia, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.