Active NPI
Kenneth Wayne Herrold, RPH
- Pharmacist
- Edmond, OK
National Provider Identifier
1376132670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10036
- Practice address
- 3200 S Santa Fe Ave
Edmond, OK 73013-2009 - Phone
- (405) 330-8107
- Fax
- (405) 330-8267
- NPI assigned
- Jan 12, 2021
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10036 | OK | Primary |
Addresses
Primary practice location
3200 S Santa Fe Ave
Edmond, OK 73013-2009
Mailing address
PO Box 720919
Oklahoma City, OK 73172-0919
Phone (405) 330-8107
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 |
|---|---|---|---|
| 10036 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oklahoma CVS Pharmacy LLC | Past | Accepting new patients | |
| Oklahoma 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610409600000",
"number": "1376132670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 720919",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731720919",
"telephone_number": "405-330-8107",
"fax_number": "405-330-8267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 S SANTA FE AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730132009",
"telephone_number": "405-330-8107",
"fax_number": "405-330-8267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERROLD",
"first_name": "KENNETH",
"middle_name": "WAYNE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-12",
"last_updated": "2021-01-12",
"certification_date": "2021-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "10036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.