NPIMap

Organization Active NPI

Self Regional Healthcare Partners

Doing business as Edgefield Community Pharmacy

  • Community/Retail Pharmacy
  • Edgefield, SC
National Provider Identifier
1073486494
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SELF REGIONAL HEALTHCARE PARTNERS
Doing business as
Edgefield Community Pharmacy
Practice address
300 Ridge Medical Plaza Rd
Edgefield, SC 29824-4525
Phone
(803) 384-4140
Fax
(803) 384-4141
NPI assigned
Sep 24, 2025
Last updated
Sep 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Authorized official

Name
Matthew Tolbert LoganNPI 1902868078
Title
President & Ceo
Phone
(864) 725-4780

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

300 Ridge Medical Plaza Rd
Edgefield, SC 29824-4525

Mailing address

300 Ridge Medical Plaza Rd
Edgefield, SC 29824-4525
Phone (803) 384-4140

Other names 1

  • Edgefield Community Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190129003656 SC Part B Supplier - Clinic/Group Practice 1557606118 Receives reassigned benefits from 133 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Edgefield, SC; Johnston, SC

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Self Regional Healthcare Partners5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

801 Mobley St
Johnston, SC 29832
Phone (803) 275-4653

Practitioners & affiliated clinicians

Practitioners 119

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.

View all 119

NPI Registry JSON

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

{
    "created_epoch": "1758672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758672000000",
    "number": "1073486494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RIDGE MEDICAL PLAZA RD",
            "city": "EDGEFIELD",
            "state": "SC",
            "postal_code": "298244525",
            "telephone_number": "803-384-4140",
            "fax_number": "803-384-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RIDGE MEDICAL PLAZA RD",
            "city": "EDGEFIELD",
            "state": "SC",
            "postal_code": "298244525",
            "telephone_number": "803-384-4140",
            "fax_number": "803-384-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF REGIONAL HEALTHCARE PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-24",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TOLBERT",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "864-725-4780"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgefield Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgefield, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.