Active NPI
Wendell Shane Edmonson, PHARMD
- Pharmacist
- Oklahoma City, OK
National Provider Identifier
1861100604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12513
- Practice address
- 4300 W Memorial Rd
Oklahoma City, OK 73120-8362 - Phone
- (405) 752-3034
- NPI assigned
- Nov 10, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2001029138 | MO | |
| Pharmacist | 183500000X | 12513 | OK | Primary |
Addresses
Primary practice location
4300 W Memorial Rd
Oklahoma City, OK 73120-8362
Mailing address
294 Country Tyme Dr
Ozark, MO 65721-6503
Phone (417) 343-8484
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2001029138 | MO | MD | Pharmacist |
| 12513 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668038400000",
"number": "1861100604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "294 COUNTRY TYME DR",
"city": "OZARK",
"state": "MO",
"postal_code": "657216503",
"telephone_number": "417-343-8484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 W MEMORIAL RD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731208362",
"telephone_number": "405-752-3034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDMONSON",
"first_name": "WENDELL",
"middle_name": "SHANE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-10",
"last_updated": "2022-11-10",
"certification_date": "2022-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2001029138",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "12513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.