Active NPI
David Parker Pendergrast, RPH
- Pharmacist
- Fayetteville, GA
National Provider Identifier
1760789150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH012452
- Practice address
- 975 Highway 54 W
Fayetteville, GA 30214-4500 - Phone
- (770) 719-3340
- Fax
- (770) 719-5176
- NPI assigned
- Feb 21, 2011
- 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 | RPH012452 | GA | Primary |
Addresses
Primary practice location
975 Highway 54 W
Fayetteville, GA 30214-4500
Mailing address
975 Highway 54 W
Fayetteville, GA 30214-4500
Phone (770) 719-3340
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH012452 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298246400000",
"number": "1760789150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "975 HIGHWAY 54 W",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302144500",
"telephone_number": "770-719-3340",
"fax_number": "770-719-5176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 HIGHWAY 54 W",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302144500",
"telephone_number": "770-719-3340",
"fax_number": "770-719-5176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDERGRAST",
"first_name": "DAVID",
"middle_name": "PARKER",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-02-21",
"last_updated": "2011-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH012452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.