Individual provider Active NPI

Richard L Wallsten Jr., PHARMD

  • Pharmacist
  • Croton on Hudson, NY
National Provider Identifier
1710235304
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
I061806-01 Issued in MI
Practice address
5A Warren Rd
Croton on Hudson, NY 10520-1511
Phone
(269) 985-3685
NPI assigned
Aug 29, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X I061806-01 MI Primary

Addresses

Primary practice location

5A Warren Rd
Croton on Hudson, NY 10520-1511

Mailing address

5A Warren Rd
Croton on Hudson, NY 10520-1511
Phone (269) 985-3685

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

LicenseStateTypeSpecialty
I061806-01MIMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1710235304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5A WARREN RD",
            "city": "CROTON ON HUDSON",
            "state": "NY",
            "postal_code": "105201511",
            "telephone_number": "269-985-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5A WARREN RD",
            "city": "CROTON ON HUDSON",
            "state": "NY",
            "postal_code": "105201511",
            "telephone_number": "269-985-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLSTEN",
        "first_name": "RICHARD",
        "middle_name": "L",
        "name_suffix": "Jr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-29",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "I061806-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Croton on Hudson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.