Active NPI
Tierra Wyatt-Young
- Pharmacist
- San Antonio, TX
National Provider Identifier
1679186977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 65612
- Practice address
- 4703 W Commerce St # at
San Antonio, TX 78237-1502 - Phone
- (210) 434-5565
- NPI assigned
- Aug 26, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 65612 | TX | Primary |
Addresses
Primary practice location
4703 W Commerce St # at
San Antonio, TX 78237-1502
Mailing address
11710 Parliament St Apt 2404
San Antonio, TX 78213-5102
Phone (937) 522-1318
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rxm.04552@store.walgreens.com |
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 |
|---|---|---|---|
| 65612 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598400000000",
"number": "1679186977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11710 PARLIAMENT ST APT 2404",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782135102",
"telephone_number": "937-522-1318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4703 W COMMERCE ST # AT",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782371502",
"telephone_number": "210-434-5565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT-YOUNG",
"first_name": "TIERRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-26",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "65612",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rxm.04552@store.walgreens.com",
"affiliation": "N",
"address_1": "4703 W Commerce St # At",
"city": "San Antonio",
"state": "TX",
"country_code": "US",
"postal_code": "782371502",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.