Active NPI
Tanya Ray Clark, RPH
- Pharmacist
- Bentonville, AR
National Provider Identifier
1366042566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD09503
- Practice address
- 3500 SE Club Blvd
Bentonville, AR 72712-5182 - Phone
- (479) 621-0283
- NPI assigned
- Oct 27, 2020
- 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 | PD09503 | AR | Primary |
Addresses
Primary practice location
3500 SE Club Blvd
Bentonville, AR 72712-5182
Mailing address
302 Cascade LN
Cave Springs, AR 72718-5504
Phone (479) 721-9267
Other practice location 1
302 Cascade Ln
Cave Springs, AR 72718-5504
Phone (479) 721-9267
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
| License | State | Type | Specialty |
|---|---|---|---|
| PD09503 | AR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1366042566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 CASCADE LN",
"city": "CAVE SPRINGS",
"state": "AR",
"postal_code": "727185504",
"telephone_number": "479-721-9267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 SE CLUB BLVD",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727125182",
"telephone_number": "479-621-0283"
}
],
"practiceLocations": [
{
"address_1": "302 Cascade Ln",
"address_purpose": "LOCATION",
"city": "Cave Springs",
"state": "AR",
"postal_code": "727185504",
"country_code": "US",
"telephone_number": "479-721-9267",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "TANYA",
"middle_name": "RAY",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-27",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD09503",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bentonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.