NPIMap

Organization Active NPI

Medicine Mart Columbia, Inc.

Doing business as Medicine Mart Pharmacy

  • Community/Retail Pharmacy
  • Columbia, SC
National Provider Identifier
1013004217
Registry record updated Jul 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
17915 Issued in SC
Legal business name
MEDICINE MART COLUMBIA, INC.
Doing business as
Medicine Mart Pharmacy
Practice address
3729 Rosewood Dr
Columbia, SC 29205
Phone
(803) 231-2003
Fax
(803) 231-2004
NPI assigned
Oct 7, 2006
Last updated
Jul 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2018

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

Authorized official

Name
Andrew David WallNPI 1932571148
Title
Owner/Pharmacist-in-Charge
Phone
(803) 231-2003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 17915 SC Primary

Addresses

Primary practice location

3729 Rosewood Dr
Columbia, SC 29205

Mailing address

3729 Rosewood Dr
Columbia, SC 29205-3531
Phone (803) 231-2003

Other identifiers 1

IdentifierTypeStateIssuer
71791DMedicaidSC

Other names 1

  • MEDICINE MART PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medicine Mart Columbia Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530576000000",
    "number": "1013004217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3729 ROSEWOOD DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292053531",
            "telephone_number": "803-231-2003",
            "fax_number": "803-231-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3729 ROSEWOOD DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29205",
            "telephone_number": "803-231-2003",
            "fax_number": "803-231-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MART COLUMBIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2018-07-03",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/PHARMACIST-IN-CHARGE",
        "authorized_official_telephone_number": "803-231-2003"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "17915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71791D",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE MART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEDICINE MART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2018; 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.