Active NPI
Amberly Rosa Wyatt, PHARMD
- Pharmacist
- Graham, NC
National Provider Identifier
1194956177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17728
- Practice address
- 841 S Main St
Graham, NC 27253-3763 - Phone
- (336) 228-6667
- NPI assigned
- Aug 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17728 | NC | Primary |
Addresses
Primary practice location
841 S Main St
Graham, NC 27253-3763
Mailing address
841 S Main St
Graham, NC 27253-3763
Phone (336) 228-6667
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0015938 | Medicaid | NC |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 17728 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249603200000",
"number": "1194956177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "841 S MAIN ST",
"city": "GRAHAM",
"state": "NC",
"postal_code": "272533763",
"telephone_number": "336-228-6667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "841 S MAIN ST",
"city": "GRAHAM",
"state": "NC",
"postal_code": "272533763",
"telephone_number": "336-228-6667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "AMBERLY",
"middle_name": "ROSA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-07",
"last_updated": "2009-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "17728",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015938",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Graham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.