Mary R Wyatt, PHARM D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

2022032015 Issued in MO

Practice address

3001 Oak Grove Rd
Poplar Bluff, MO 63901-8942

Phone

(573) 772-7169

NPI assigned

Sep 14, 2022

Last updated

Sep 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Mary R Payne Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-7127

  • Community/Retail Pharmacy
  • Poplar Bluff, MO
  • NPI 1184027211
  NPD (past)
• Wal-Mart Stores East, LP

  dba Walmart Pharmacy 10-2229

  • Pharmacy
  • Apollo Beach, FL
  • NPI 1437027208
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1437871704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 WOODSTONE DR",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012561",
            "telephone_number": "573-718-7573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018942",
            "telephone_number": "573-772-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "MARY",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "PHARM D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-14",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2022032015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "PAYNE",
            "middle_name": "R",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nathaniel Lynn Woodruff
• Cerendia Woollums, LPC
• Jonathan Workman, DO
• Barbara E Worley
• Tom Wright, H.I.S.
• Mitzi Wynne
• Shellie R Yarbro
• Jessica Rene Yeley, MSN,APRN,FNP-BC
• Lance F Yeoman, D.O.
• Alyssa Leeann Yoder

• Pharmacist in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.