Palmetto Specialty Pharm LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PALMETTO SPECIALTY PHARM LLC

Practice address

1200 Two Island CT Unit B
Mount Pleasant, SC 29466-7418

Phone

(843) 972-7704

Fax

(843) 972-9395

NPI assigned

Oct 14, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Joseph Fennick, PHARMD

Title

Ceo

Phone

(843) 972-7704

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Palmetto Pharm Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Tax ID family

Palmetto Pharm3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Palmetto Specialty Pharm LLC

  • Specialty Pharmacy
  • Mount Pleasant, SC
  • NPI 1134846322
  NPD tax ID
• Palmetto Specialty Pharm LLC

  • Mail Order Pharmacy
  • Mount Pleasant, SC
  • NPI 1164149563
  NPD tax ID

Locations

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

{
    "created_epoch": "1665705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1114643749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 TWO ISLAND CT UNIT B",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294667418",
            "telephone_number": "843-972-7704",
            "fax_number": "843-972-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 TWO ISLAND CT UNIT B",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294667418",
            "telephone_number": "843-972-7704",
            "fax_number": "843-972-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO SPECIALTY PHARM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-14",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "FENNICK",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-972-7704",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "20906",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.palmettopharm.com",
            "affiliation": "N",
            "endpointDescription": "URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1200 Two Island Ct Unit B",
            "city": "Mount Pleasant",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294667418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Palmetto Pharm",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Palmetto Pharm",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Palmetto Primary Care Physicians, LLC
• Palmetto Specialty Pharm LLC
• Palmetto Specialty Pharm LLC
• Palmetto Therapeutic Medicine LLC
• Palmetto Women'S Health, PC
• Palmetto Women'S Health, PC

• Community/Retail Pharmacy in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Community/Retail Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; 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.