NPIMap

Organization Active NPI

Self Regional Healthcare

Doing business as Self Regional Healthcare Pharmacy Epting

  • Community/Retail Pharmacy
  • Greenwood, SC
National Provider Identifier
1366313645
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SELF REGIONAL HEALTHCARE
Doing business as
Self Regional Healthcare Pharmacy Epting
Practice address
520 Epting Ave
Greenwood, SC 29646-4091
Phone
(864) 725-4172
Fax
(864) 725-4164
NPI assigned
Sep 17, 2025
Last updated
Sep 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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

Authorized official

Name
Matthew Tolbert Logan
Title
President & Ceo
Phone
(864) 725-4780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

520 Epting Ave
Greenwood, SC 29646-4091

Mailing address

104 Wells Ave
Greenwood, SC 29646-3837
Phone (864) 725-4673

Other names 1

  • Self Regional Healthcare Pharmacy Epting Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051214000767 SC Part B Supplier - Clinic/Group Practice 4082527742 Receives reassigned benefits from 234 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenwood, SC; Clinton, SC; Ware Shoals, SC; Saluda, SC; Ninety Six, SC; Newberry, SC; MC Cormick, SC; Laurens, SC…

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

National Provider Directory

National Provider Directory
Tax ID family
Lawrence B Beasley MD49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Locations

520 Epting Ave
Greenwood, SC 29646
Phone (864) 725-4172

NPI Registry JSON

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

{
    "created_epoch": "1758067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1366313645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WELLS AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463837",
            "telephone_number": "864-725-4673",
            "fax_number": "864-725-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 EPTING AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296464091",
            "telephone_number": "864-725-4172",
            "fax_number": "864-725-4164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF REGIONAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-17",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TOLBERT",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "864-725-4780"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Self Regional Healthcare Pharmacy Epting",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenwood, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; 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.