Active NPI
Thomas Hall Stark III, PHARMD
- Pharmacist
- Pea Ridge, AR
National Provider Identifier
1417579772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD12270
- Practice address
- 240 Slack St
Pea Ridge, AR 72751-3759 - Phone
- (479) 451-9008
- NPI assigned
- May 9, 2020
- Last updated
- May 9, 2020
- 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 | PD12270 | AR | Primary |
Addresses
Primary practice location
240 Slack St
Pea Ridge, AR 72751-3759
Mailing address
1428 Le Chesnay Dr
Centerton, AR 72719-8805
Phone (479) 644-4136
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD12270 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart 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": "1588982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588982400000",
"number": "1417579772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1428 LE CHESNAY DR",
"city": "CENTERTON",
"state": "AR",
"postal_code": "727198805",
"telephone_number": "479-644-4136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 SLACK ST",
"city": "PEA RIDGE",
"state": "AR",
"postal_code": "727513759",
"telephone_number": "479-451-9008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "THOMAS",
"middle_name": "HALL",
"name_suffix": "III",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-09",
"last_updated": "2020-05-09",
"certification_date": "2020-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD12270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pea Ridge, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.