Active NPI
Thomas Danville Wallace, CPHT
- Pharmacy Technician
- Waynesboro, TN
National Provider Identifier
1265787147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 37742
- Practice address
- 215 Dexter L Woods Memorial Blvd
Waynesboro, TN 38485-2416 - Phone
- (931) 722-5466
- NPI assigned
- Jul 17, 2012
- Last updated
- Jul 17, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 37742 | TN | Primary |
Addresses
Primary practice location
215 Dexter L Woods Memorial Blvd
Waynesboro, TN 38485-2416
Mailing address
501 Highway 64 W
Waynesboro, TN 38485-2355
Phone (931) 722-3605
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
| License | State | Type | Specialty |
|---|---|---|---|
| 37742 | TN | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duren Clinical Services, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Duren Pharmacy
- Community/Retail Pharmacy
- Waynesboro, TN
- NPI 1821054289
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342483200000",
"number": "1265787147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 HIGHWAY 64 W",
"city": "WAYNESBORO",
"state": "TN",
"postal_code": "384852355",
"telephone_number": "931-722-3605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 DEXTER L WOODS MEMORIAL BLVD",
"city": "WAYNESBORO",
"state": "TN",
"postal_code": "384852416",
"telephone_number": "931-722-5466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "THOMAS",
"middle_name": "DANVILLE",
"credential": "CPHT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-17",
"last_updated": "2012-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "TN",
"license": "37742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waynesboro, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.