NPIMap

Organization Active NPI

Professional Pharmacy at Mt View in

  • Community/Retail Pharmacy
  • Greer, SC
National Provider Identifier
1306829668
Registry record updated May 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
50001504 Issued in SC
Legal business name
PROFESSIONAL PHARMACY AT MT VIEW IN
Practice address
428 Memorial Drive Extension
Greer, SC 29651-1818
Phone
(864) 877-4281
Fax
(864) 877-4077
NPI assigned
Nov 21, 2005
Last updated
May 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2016

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

Authorized official

Name
Mr. Paula Jagina King Jr., RPH
Title
Pharmacist in Charge
Phone
(864) 877-4281

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X 50001504 SC Primary

Addresses

Primary practice location

428 Memorial Drive Extension
Greer, SC 29651-1818

Mailing address

428 Memorial Drive Ext
Greer, SC 29651-1818
Phone (864) 877-4281

Other identifiers 2

IdentifierTypeStateIssuer
715040MedicaidSC
4210592OtherNABP NUMBER

National Provider Directory

National Provider Directory

Locations

428 Memorial Drive Ext
Greer, SC 29651
Phone (864) 877-4281

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464134400000",
    "number": "1306829668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 MEMORIAL DRIVE EXT",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511818",
            "telephone_number": "864-877-4281",
            "fax_number": "864-877-4077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 MEMORIAL DRIVE EXTENSION",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511818",
            "telephone_number": "864-877-4281",
            "fax_number": "864-877-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PHARMACY AT MT VIEW IN",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-21",
        "last_updated": "2016-05-25",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "JAGINA",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "864-877-4281",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "50001504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "715040",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "4210592",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greer, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.