Active NPI
Pamela C Martin
- Pharmacist
- Rincon, GA
National Provider Identifier
1063783595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17654
- Practice address
- 5633 Hwy 21 S
Rincon, GA 31326-9416 - Phone
- (912) 826-7665
- Fax
- (912) 826-7667
- NPI assigned
- Jan 13, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17654 | GA | Primary |
| Pharmacist | 183500000X | 9882 | SC |
Addresses
Primary practice location
5633 Hwy 21 S
Rincon, GA 31326-9416
Mailing address
5633 Hwy 21 S
Rincon, GA 31326-9416
Phone (912) 826-7665
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 |
|---|---|---|---|
| 9882 | SC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Co | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326412800000",
"number": "1063783595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5633 HWY 21 S",
"city": "RINCON",
"state": "GA",
"postal_code": "313269416",
"telephone_number": "912-826-7665",
"fax_number": "912-826-7667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5633 HWY 21 S",
"city": "RINCON",
"state": "GA",
"postal_code": "313269416",
"telephone_number": "912-826-7665",
"fax_number": "912-826-7667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "PAMELA",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-13",
"last_updated": "2012-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "17654",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "9882",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rincon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.