Active NPI
Kellie W Waldrip, RPH
- Pharmacist
- Southaven, MS
National Provider Identifier
1508108002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E08849
- Practice address
- 984 Main St
Southaven, MS 38671-1509 - Phone
- (662) 342-1915
- Fax
- (662) 393-0421
- NPI assigned
- Mar 22, 2013
- 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 | E08849 | MS | Primary |
Addresses
Primary practice location
984 Main St
Southaven, MS 38671-1509
Mailing address
984 Main St
Southaven, MS 38671-1509
Phone (662) 342-1915
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 |
|---|---|---|---|
| E08849 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413331200000",
"number": "1508108002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "984 MAIN ST",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386711509",
"telephone_number": "662-342-1915",
"fax_number": "662-393-0421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "984 MAIN ST",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386711509",
"telephone_number": "662-342-1915",
"fax_number": "662-393-0421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDRIP",
"first_name": "KELLIE",
"middle_name": "W",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-22",
"last_updated": "2014-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E08849",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.