Active NPI
Randy Paul Stayton
- Pharmacist
- Russellville, AR
National Provider Identifier
1962002782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD08199
- Practice address
- 2109 W Main
Russellville, AR 72801 - Phone
- (479) 498-9540
- Fax
- (479) 498-9543
- NPI assigned
- Oct 30, 2020
- 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 | PD08199 | AR | Primary |
Addresses
Primary practice location
2109 W Main
Russellville, AR 72801
Mailing address
503 Walleye Dr
Russellville, AR 72802-7298
Phone (479) 747-1409
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 |
|---|---|---|---|
| PD08199 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart Inc. | 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Russellville, AR
- NPI 1629481395
-
- Community/Retail Pharmacy
- Eastvale, CA
- NPI 1770458945
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604016000000",
"number": "1962002782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 WALLEYE DR",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728027298",
"telephone_number": "479-747-1409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2109 W MAIN",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "72801",
"telephone_number": "479-498-9540",
"fax_number": "479-498-9543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAYTON",
"first_name": "RANDY",
"middle_name": "PAUL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-30",
"last_updated": "2020-10-30",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD08199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.