Active NPI
Robert Lee Poulos Jr., PHARMD.
- Pharmacist
- Myrtle Beach, SC
National Provider Identifier
1013326198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 35721
- Practice address
- 3701 N Kings Hwy
Myrtle Beach, SC 29577-2977 - Phone
- (843) 448-9104
- NPI assigned
- Aug 4, 2014
- Last updated
- Aug 4, 2014
- Sex
- Male
- Sole proprietor
- No
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 | 35721 | SC | Primary |
Addresses
Primary practice location
3701 N Kings Hwy
Myrtle Beach, SC 29577-2977
Mailing address
4758 Lightkeepers Way Unit 23B
Little River, SC 29566-7960
Phone (843) 530-0733
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 |
|---|---|---|---|
| 35721 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407110400000",
"number": "1013326198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4758 LIGHTKEEPERS WAY UNIT 23B",
"city": "LITTLE RIVER",
"state": "SC",
"postal_code": "295667960",
"telephone_number": "843-530-0733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3701 N KINGS HWY",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295772977",
"telephone_number": "843-448-9104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULOS",
"first_name": "ROBERT",
"middle_name": "LEE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PHARMD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-04",
"last_updated": "2014-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "35721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.