Active NPI
Tristan Myers
- Pharmacist
- Springdale, AR
National Provider Identifier
1336742873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD12820
- Practice address
- 2001 S Thompson St
Springdale, AR 72764-6329 - Phone
- (479) 927-1568
- NPI assigned
- Nov 18, 2020
- Last updated
- Nov 18, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | PD12820 | AR | Primary |
Addresses
Primary practice location
2001 S Thompson St
Springdale, AR 72764-6329
Mailing address
2001 S Thompson St
Springdale, AR 72764-6329
Phone (479) 927-1568
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 |
|---|---|---|---|
| PD12820 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arkansas CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Arkansas CVS Pharmacy LLC | 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": "1605657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1336742873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 S THOMPSON ST",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727646329",
"telephone_number": "479-927-1568",
"fax_number": "479-927-1879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 S THOMPSON ST",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727646329",
"telephone_number": "479-927-1568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYERS",
"first_name": "TRISTAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD12820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springdale, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.