Active NPI
Penny Wyatt
- Pharmacist
- Martinsville, VA
National Provider Identifier
1427658657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202006386
- Practice address
- 976 Commonwealth Blvd
Martinsville, VA 24112-1887 - Phone
- (276) 638-2905
- NPI assigned
- Oct 27, 2020
- Sex
- Female
- 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 | 0202006386 | VA | Primary |
Addresses
Primary practice location
976 Commonwealth Blvd
Martinsville, VA 24112-1887
Mailing address
1005 River Forest PL
Martinsville, VA 24112-5515
Phone (276) 638-3780
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 |
|---|---|---|---|
| 0202006386 | VA | 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": "1427658657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1005 RIVER FOREST PL",
"city": "MARTINSVILLE",
"state": "VA",
"postal_code": "241125515",
"telephone_number": "276-638-3780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "976 COMMONWEALTH BLVD",
"city": "MARTINSVILLE",
"state": "VA",
"postal_code": "241121887",
"telephone_number": "276-638-2905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "PENNY",
"sole_proprietor": "YES",
"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": "VA",
"license": "0202006386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinsville, VA
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.