Active NPI
Robert W Wyatt
- Pharmacist
- Spartanburg, SC
National Provider Identifier
1700209905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5949
- Practice address
- 203 Cedar Springs Rd
Spartanburg, SC 29302 - Phone
- (864) 381-6366
- Fax
- (864) 381-6367
- NPI assigned
- Jan 24, 2014
- Last updated
- Aug 19, 2015
- 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 | 183500000X | 5949 | SC | Primary |
Addresses
Primary practice location
203 Cedar Springs Rd
Spartanburg, SC 29302
Mailing address
203 Cedar Springs Rd
Spartanburg, SC 29302-4639
Phone (864) 381-6366
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5949 | Other | SC | SC LIC PHARMACIST |
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 |
|---|---|---|---|
| 5949 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Wal-Mart Stores East, LP | Past | Accepting new patients |
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.
-
dba Walmart Pharmacy 10-3338
- Community/Retail Pharmacy
- Spartanburg, SC
- NPI 1114306735
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439942400000",
"number": "1700209905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 CEDAR SPRINGS RD",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293024639",
"telephone_number": "864-381-6366",
"fax_number": "864-381-6367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 CEDAR SPRINGS RD",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "29302",
"telephone_number": "864-381-6366",
"fax_number": "864-381-6367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "ROBERT",
"middle_name": "W",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-24",
"last_updated": "2015-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "5949",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC LIC PHARMACIST",
"identifier": "5949",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spartanburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.