Active NPI
Caleb Bryant Sample
- Pharmacist
- Lebanon, VA
National Provider Identifier
1770173445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202219104
- Practice address
- 159 Pittston Rd
Lebanon, VA 24266-4630 - Phone
- (276) 889-5914
- NPI assigned
- Jan 26, 2021
- 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 | 0202219104 | VA | Primary |
Addresses
Primary practice location
159 Pittston Rd
Lebanon, VA 24266-4630
Mailing address
403 Grand View CT
Rosedale, VA 24280-3597
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 |
|---|---|---|---|
| 0202219104 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611619200000",
"number": "1770173445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 GRAND VIEW CT",
"city": "ROSEDALE",
"state": "VA",
"postal_code": "242803597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 PITTSTON RD",
"city": "LEBANON",
"state": "VA",
"postal_code": "242664630",
"telephone_number": "276-889-5914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMPLE",
"first_name": "CALEB",
"middle_name": "BRYANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-26",
"last_updated": "2021-01-26",
"certification_date": "2021-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202219104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.