Blaze Justin Calderon

Primary specialty

PharmacistTaxonomy code 183500000X

License

PD15469 Issued in AR

Practice address

551 Liberty Dr
Greenwood, AR 72936-6001

Phone

(479) 996-8533

NPI assigned

Feb 16, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walmart Inc.

  • Community/Retail Pharmacy
  • Greenwood, AR
  • NPI 1770500175
  NPD (past)
• Walmart Inc.

  • Community/Retail Pharmacy
  • Eastvale, CA
  • NPI 1770458945
  NPD (past)

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

{
    "created_epoch": "1613433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1881287266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8036 MASSARD RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729167030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 LIBERTY DR",
            "city": "GREENWOOD",
            "state": "AR",
            "postal_code": "729366001",
            "telephone_number": "479-996-8533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALDERON",
        "first_name": "BLAZE",
        "middle_name": "JUSTIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-16",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD15469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brent W. Dunavin, D.D.S
• Shelbe Dale Brooks, LMT
• Haley Marie Brown, LPTA
• Brownfield Pharmacy Inc
• Dustin Brownfield, PHARMD
• Makayla Carney
• Lisa Michele Chatfield, LMT
• Gayla Dawn Claborn, LPC
• Mary Katherine Clark, M.S.,LPE-I
• Lisa Jan Bohne Clay, MED

• Pharmacist in Greenwood, AR
• Providers in Greenwood, AR by specialty
• Pharmacist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.

Verify at the official NPI Registry.