Individual provider Active NPI

Roy Dean Walker, PD

  • Pharmacist
  • Russellville, AR
National Provider Identifier
1619564317
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
AR06874 Issued in AR
Practice address
121 N Commerce Ave
Russellville, AR 72801-3790
Phone
(479) 968-2456
Fax
(479) 968-7914
NPI assigned
Dec 29, 2020
Last updated
Dec 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X AR06874 AR Primary

Addresses

Primary practice location

121 N Commerce Ave
Russellville, AR 72801-3790

Mailing address

121 N Commerce Ave
Russellville, AR 72801-3790
Phone (479) 968-2456

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address candddrugstore@suddenlinkmail.com Direct

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

LicenseStateTypeSpecialty
AR06874ARMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
C & D Drug Store Inc CurrentSince Jan 3, 2021 Accepting new patients
C & D Drug Store CurrentSince Jun 9, 2024 Accepting new patients

Locations

121 N Commerce Ave
Russellville, AR 72801
Phone (479) 968-2456

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": "1609200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1619564317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 N COMMERCE AVE",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013790",
            "telephone_number": "479-968-2456",
            "fax_number": "479-968-7914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N COMMERCE AVE",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013790",
            "telephone_number": "479-968-2456",
            "fax_number": "479-968-7914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "ROY",
        "middle_name": "DEAN",
        "credential": "PD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-29",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "AR06874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "candddrugstore@suddenlinkmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "121 N Commerce Ave",
            "city": "Russellville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "728013790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.

Verify at the official NPI Registry.