Active NPI
Ronald Lynn Headley, PD
- Pharmacist
- Malvern, AR
National Provider Identifier
1679859375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 06034
- Practice address
- 308 S Main St
Malvern, AR 72104-3737 - Phone
- (501) 467-8197
- Fax
- (501) 467-8662
- NPI assigned
- Oct 25, 2011
- Sex
- Male
- 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 | 06034 | AR | Primary |
Addresses
Primary practice location
308 S Main St
Malvern, AR 72104-3737
Mailing address
1664 Circle Dr
Malvern, AR 72104-4508
Phone (501) 467-8197
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 |
|---|---|---|---|
| 06034 | AR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319500800000",
"number": "1679859375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1664 CIRCLE DR",
"city": "MALVERN",
"state": "AR",
"postal_code": "721044508",
"telephone_number": "501-467-8197",
"fax_number": "501-467-8662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 S MAIN ST",
"city": "MALVERN",
"state": "AR",
"postal_code": "721043737",
"telephone_number": "501-467-8197",
"fax_number": "501-467-8662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEADLEY",
"first_name": "RONALD",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-25",
"last_updated": "2011-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "06034",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malvern, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.