Active NPI
Tharyar Myatnoe Wilm
- Pharmacist
- North Charleston, SC
National Provider Identifier
1124847371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 60389
- Practice address
- 8995 University Blvd
North Charleston, SC 29406-9116 - Phone
- (415) 916-7466
- NPI assigned
- Oct 5, 2024
- Last updated
- Oct 5, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | 60389 | SC | Primary |
Addresses
Primary practice location
8995 University Blvd
North Charleston, SC 29406-9116
Mailing address
5863 Andreas Way
North Charleston, SC 29418-5201
Phone (415) 916-7466
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 |
|---|---|---|---|
| 60389 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728086400000",
"number": "1124847371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5863 ANDREAS WAY",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294185201",
"telephone_number": "415-916-7466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8995 UNIVERSITY BLVD",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294069116",
"telephone_number": "415-916-7466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILM",
"first_name": "THARYAR",
"middle_name": "MYATNOE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-05",
"last_updated": "2024-10-05",
"certification_date": "2024-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "60389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.