Active NPI
Gerardo Martin, RPH.
- Pharmacist
- Lake Wylie, SC
National Provider Identifier
1083032999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9397
- Practice address
- 175 Highway 274
Lake Wylie, SC 29710-6045 - Phone
- (803) 619-7028
- NPI assigned
- Mar 29, 2014
- Last updated
- Mar 29, 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 | 9397 | SC | Primary |
Addresses
Primary practice location
175 Highway 274
Lake Wylie, SC 29710-6045
Mailing address
175 Highway 274
Lake Wylie, SC 29710-6045
Phone (803) 619-7028
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9397 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396051200000",
"number": "1083032999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 HIGHWAY 274",
"city": "LAKE WYLIE",
"state": "SC",
"postal_code": "297106045",
"telephone_number": "803-619-7028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 HIGHWAY 274",
"city": "LAKE WYLIE",
"state": "SC",
"postal_code": "297106045",
"telephone_number": "803-619-7028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "GERARDO",
"name_prefix": "Mr.",
"credential": "RPH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-29",
"last_updated": "2014-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "9397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Wylie, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.