Active NPI
Ty Garrison, PHARMACIST
- Pharmacist
- Clarksburg, WV
National Provider Identifier
1598370504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP0010617
- Practice address
- 701 E Main St
Clarksburg, WV 26301-3225 - Phone
- (304) 624-0161
- NPI assigned
- Sep 15, 2020
- Last updated
- Sep 15, 2020
- 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 | RP0010617 | WV | Primary |
Addresses
Primary practice location
701 E Main St
Clarksburg, WV 26301-3225
Mailing address
1347 Goose Run Rd
Fairmont, WV 26554-1313
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 |
|---|---|---|---|
| RP0010617 | WV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Virginia CVS Pharmacy LLC | Past | Accepting new patients | |
| West Virginia CVS Pharmacy LLC | 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": "1600128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600128000000",
"number": "1598370504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1347 GOOSE RUN RD",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265541313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 E MAIN ST",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "263013225",
"telephone_number": "304-624-0161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARRISON",
"first_name": "TY",
"name_prefix": "Dr.",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-15",
"last_updated": "2020-09-15",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0010617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.