NPIMap

Individual provider Active NPI

Bradley Renick

  • Pharmacist
  • Mena, AR
National Provider Identifier
1235434440
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PD10589 Issued in AR
Practice address
1201 Highway 71 S
Mena, AR 71953-8007
Phone
(479) 394-7136
NPI assigned
Jan 19, 2011
Last updated
Jan 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PD10589 AR Primary

Addresses

Primary practice location

1201 Highway 71 S
Mena, AR 71953-8007

Mailing address

1201 Highway 71 S
Mena, AR 71953-8007

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

State licenses

LicenseStateTypeSpecialty
PD10589ARMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Freds Stores of Tennessee Inc Past Accepting new patients
Freds Stores of Tennessee Inc Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295395200000",
    "number": "1235434440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 HIGHWAY 71 S",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719538007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 HIGHWAY 71 S",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719538007",
            "telephone_number": "479-394-7136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENICK",
        "first_name": "BRADLEY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-19",
        "last_updated": "2011-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD10589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mena, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; 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.