Active NPI
Wyatt Marshal Connelley, PHARMD,RPH
- Pharmacist
- Gulfport, MS
National Provider Identifier
1851778989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-13587
- Practice address
- 11333 Highway 49
Gulfport, MS 39503-3130 - Phone
- (228) 284-6113
- Fax
- (228) 284-6112
- NPI assigned
- Apr 27, 2015
- Last updated
- May 28, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PST.024270 | LA | |
| Pharmacist | 183500000X | E-13587 | MS | Primary |
Addresses
Primary practice location
11333 Highway 49
Gulfport, MS 39503-3130
Mailing address
11333 Highway 49
Gulfport, MS 39503-3130
Phone (228) 284-6113
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, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.024270 | LA | MD | Pharmacist |
| E-13587 | MS | 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 10-6323
- Community/Retail Pharmacy
- Gulfport, MS
- NPI 1215321716
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653696000000",
"number": "1851778989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11333 HIGHWAY 49",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395033130",
"telephone_number": "228-284-6113",
"fax_number": "228-284-6112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11333 HIGHWAY 49",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395033130",
"telephone_number": "228-284-6113",
"fax_number": "228-284-6112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELLEY",
"first_name": "WYATT",
"middle_name": "MARSHAL",
"credential": "PHARMD,RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-27",
"last_updated": "2022-05-28",
"certification_date": "2022-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.024270",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-13587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.