Active NPI
Michael Ericson Clark, PHARMD
- Pharmacist
- Aiken, SC
National Provider Identifier
1376801290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13704
- Practice address
- 2062 Whiskey Rd
Aiken, SC 29803-6183 - Phone
- (803) 648-2339
- Fax
- (803) 502-0971
- NPI assigned
- Apr 28, 2012
- Sex
- Male
- 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 | 13704 | SC | Primary |
Addresses
Primary practice location
2062 Whiskey Rd
Aiken, SC 29803-6183
Mailing address
2062 Whiskey Rd
Aiken, SC 29803-6183
Phone (803) 648-2339
Other practice location 1
190 Crepe Myrtle Ct
Aiken, SC 29803-7543
Phone (803) 648-7800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13704 | Other | SC | PHARMACIST LICENSE |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13704 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Total Care Medical Center LLC | Past | Accepting new patients | |
| TLC Medical Centre, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Aiken, SC
- NPI 1720070972
-
- Community/Retail Pharmacy
- Aiken, SC
- NPI 1821117375
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1376801290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2062 WHISKEY RD",
"city": "AIKEN",
"state": "SC",
"postal_code": "298036183",
"telephone_number": "803-648-2339",
"fax_number": "803-502-0971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2062 WHISKEY RD",
"city": "AIKEN",
"state": "SC",
"postal_code": "298036183",
"telephone_number": "803-648-2339",
"fax_number": "803-502-0971"
}
],
"practiceLocations": [
{
"address_1": "190 Crepe Myrtle Ct",
"address_purpose": "LOCATION",
"city": "Aiken",
"state": "SC",
"postal_code": "298037543",
"country_code": "US",
"telephone_number": "803-648-7800",
"fax_number": "803-648-7277",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "MICHAEL",
"middle_name": "ERICSON",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-28",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "13704",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "13704",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aiken, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.