Active NPI
Shelby Wall, PHARMD
- Pharmacist
- Pine Bluff, AR
National Provider Identifier
1679273189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD16239
- Practice address
- 2701 E Harding Ave
Pine Bluff, AR 71601-6849 - Phone
- (870) 380-6901
- NPI assigned
- Mar 6, 2023
- 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 | PD16239 | AR | Primary |
Addresses
Primary practice location
2701 E Harding Ave
Pine Bluff, AR 71601-6849
Mailing address
4023 Hawthorne LN
Pine Bluff, AR 71603-9030
Phone (501) 612-3824
Other practice location 1
2302 W 28th Ave Ste B
Pine Bluff, AR 71603-5081
Phone (870) 671-4914
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD16239 | AR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678060800000",
"number": "1679273189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4023 HAWTHORNE LN",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716039030",
"telephone_number": "501-612-3824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 E HARDING AVE",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716016849",
"telephone_number": "870-380-6901"
}
],
"practiceLocations": [
{
"address_1": "2302 W 28th Ave Ste B",
"address_purpose": "LOCATION",
"city": "Pine Bluff",
"state": "AR",
"postal_code": "716035081",
"country_code": "US",
"telephone_number": "870-671-4914",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALL",
"first_name": "SHELBY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-06",
"last_updated": "2023-03-06",
"certification_date": "2023-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD16239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.