NPIMap

Individual provider Active NPI

Robert Steven Waddy, RPH

  • Pharmacist
  • Mineral Wells, TX
National Provider Identifier
1174674667
Registry record updated Jul 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
25375 Issued in TX
Practice address
106 SW 6TH Ave
Mineral Wells, TX 76067-5129
Phone
(940) 325-0734
Fax
(940) 328-1991
NPI assigned
Jan 13, 2007
Last updated
Jul 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 25375 TX Primary

Addresses

Primary practice location

106 SW 6TH Ave
Mineral Wells, TX 76067-5129

Mailing address

106 SW 6TH Ave
Mineral Wells, TX 76067-5129
Phone (940) 325-0734

Other identifiers 2

IdentifierTypeStateIssuer
144374MedicaidTX
25375OtherTXPHARMACY LISC. NUMBER

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

LicenseStateTypeSpecialty
25375TXMDPharmacist

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1168646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1174674667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 SW 6TH AVE",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760675129",
            "telephone_number": "940-325-0734",
            "fax_number": "940-328-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 SW 6TH AVE",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760675129",
            "telephone_number": "940-325-0734",
            "fax_number": "940-328-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDY",
        "first_name": "ROBERT",
        "middle_name": "STEVEN",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-13",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "25375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144374",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LISC. NUMBER",
            "identifier": "25375",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineral Wells, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; 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.