Active NPI
Gavin Brunson
- Pharmacist
- Clarksville, AR
National Provider Identifier
1457031916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD16659
- Practice address
- 230 E Market St
Clarksville, AR 72830-9069 - Phone
- (479) 754-6169
- NPI assigned
- Jul 20, 2023
- Last updated
- Jul 20, 2023
- Sex
- Male
- 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 | PD16659 | AR | Primary |
Addresses
Primary practice location
230 E Market St
Clarksville, AR 72830-9069
Mailing address
26 Saia Mountain Dr
Plainview, AR 72857-9029
Phone (318) 278-2176
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 |
|---|---|---|---|
| PD16659 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients |
Organizations & group practices 1
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": "1689811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689811200000",
"number": "1457031916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 SAIA MOUNTAIN DR",
"city": "PLAINVIEW",
"state": "AR",
"postal_code": "728579029",
"telephone_number": "318-278-2176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 E MARKET ST",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "728309069",
"telephone_number": "479-754-6169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNSON",
"first_name": "GAVIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-20",
"last_updated": "2023-07-20",
"certification_date": "2023-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD16659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.