Ocean Lakes Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

50004721 Issued in SC

Legal business name

OCEAN LAKES PHARMACY INC

Doing business as

Ocean Lakes Pharmacy Inc

Practice address

1415 Hwy 17 Business N
Surfside Beach, SC 29575

Phone

(843) 238-5159

Fax

(843) 238-8270

NPI assigned

Oct 23, 2006

Last updated

Feb 28, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Roger Williams

Title

Owner

Phone

(848) 238-5159

Specialties & licenses 4

Addresses

Other identifiers 4

Other names 1

• OCEAN LAKES PHARMACY INC Doing business as

Medicare fee-for-service enrollment

Enrolled in SC2 enrollments

Enrollment records 2

Locations

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.

• Joel E Shockley III, RPH

  • Pharmacist
  • Olanta, SC
  • NPI 1740499524
  NPD (past)
• Christopher Ryan Templeton, CPHT

  • Pharmacy Technician
  • Surfside Beach, SC
  • NPI 1174773691
  NPD (past)
• Gentry Marie Weatherwax, PHARMD

  • Pharmacist
  • Surfside Beach, SC
  • NPI 1932824570
  NPD (past)
• Roddy Williams

  • Pharmacist
  • Myrtle Beach, SC
  • NPI 1306881628
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1316020589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 HWY 17 BUSINESS N",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "29575",
            "telephone_number": "843-238-5159",
            "fax_number": "843-238-8270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 HWY 17 BUSINESS N",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "29575",
            "telephone_number": "843-238-5159",
            "fax_number": "843-238-8270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEAN LAKES PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "848-238-5159"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "50004721",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2088907",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "747216",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EN2106",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "611804",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OCEAN LAKES PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kaitlyn O'Neill, PHARMD
• Melanie Harpe O'Tuel, RN
• Julie Obenchain
• Daniel A Oehler, PA
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• Prudence Melinda Olsen, PA-C
• Grishma Pankhania
• John L. Pavy, DDS

• Community/Retail Pharmacy in Surfside Beach, SC
• Providers in Surfside Beach, 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 Feb 28, 2017; 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.