Active NPI
Kelly Todd Waldrip
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Horn Lake, MS
National Provider Identifier
1619508322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- E-08238
- Practice address
- 3926 Goodman Rd W
Horn Lake, MS 38637-1324 - Phone
- (662) 393-7868
- Fax
- (662) 393-1076
- NPI assigned
- Jan 31, 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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | E-08238 | MS | Primary |
Addresses
Primary practice location
3926 Goodman Rd W
Horn Lake, MS 38637-1324
Mailing address
3926 Goodman Rd W
Horn Lake, MS 38637-1324
Phone (662) 393-7868
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 |
|---|---|---|---|
| E-08238 | MS | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580428800000",
"number": "1619508322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3926 GOODMAN RD W",
"city": "HORN LAKE",
"state": "MS",
"postal_code": "386371324",
"telephone_number": "662-393-7868",
"fax_number": "662-393-1076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3926 GOODMAN RD W",
"city": "HORN LAKE",
"state": "MS",
"postal_code": "386371324",
"telephone_number": "662-393-7868",
"fax_number": "662-393-1076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDRIP",
"first_name": "KELLY",
"middle_name": "TODD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-31",
"last_updated": "2020-01-31",
"certification_date": "2020-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MS",
"license": "E-08238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Horn Lake, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.