Tyson Wallace, PHARM. D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

PD09924 Issued in AR

Practice address

134 Bevill Ave
Gosnell, AR 72315

Phone

(870) 751-9242

Fax

(870) 751-9291

NPI assigned

Feb 11, 2021

Last updated

Apr 22, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

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.

• Gosnell Drugs Inc.

  • Community/Retail Pharmacy
  • Gosnell, AR
  • NPI 1770055923
  NPD Authorized official
• Semo Drugs Inc

  • Community/Retail Pharmacy
  • Senath, MO
  • NPI 1356338669

  Pharmacist

  NPD
• Semo Drugs Inc

  dba Bootheel Drugs LTC

  • Long Term Care Pharmacy
  • Senath, MO
  • NPI 1639901259
  NPD

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1982296877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 BEVILL AVE",
            "city": "GOSNELL",
            "state": "AR",
            "postal_code": "72315",
            "telephone_number": "870-751-9242",
            "fax_number": "870-751-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 BEVILL AVE",
            "city": "GOSNELL",
            "state": "AR",
            "postal_code": "72315",
            "telephone_number": "870-751-9242",
            "fax_number": "870-751-9291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "339 E Commercial St",
            "address_purpose": "LOCATION",
            "city": "Senath",
            "state": "MO",
            "postal_code": "638769238",
            "country_code": "US",
            "telephone_number": "573-738-2097",
            "fax_number": "573-738-2233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TYSON",
        "name_prefix": "Dr.",
        "credential": "PHARM. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-11",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2007005629",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD09924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "289547795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gosnell School District
• Gosnell Therapy and Living Center, Inc.
• Whitney Johnson, PMHNP-BC
• Janet Mason, MSP CCC SLP L
• Brandon Glenn Michael, PHARM.D

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.