Individual provider Active NPI

Joe Bryan Blackwell, RPH

  • Pharmacist
  • Taylors, SC
National Provider Identifier
1376888784
Registry record updated Dec 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5549 Issued in SC
Practice address
2801 Wade Hampton Blvd
Taylors, SC 29687-2781
Phone
(864) 609-7306
Fax
(864) 609-0889
NPI assigned
Dec 11, 2012
Last updated
Dec 11, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5549 SC Primary

Addresses

Primary practice location

2801 Wade Hampton Blvd
Taylors, SC 29687-2781

Mailing address

5443 Locust Hill Rd
Travelers Rest, SC 29690-8639
Phone (864) 238-6285

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
5549SCMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355184000000",
    "number": "1376888784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5443 LOCUST HILL RD",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296908639",
            "telephone_number": "864-238-6285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 WADE HAMPTON BLVD",
            "city": "TAYLORS",
            "state": "SC",
            "postal_code": "296872781",
            "telephone_number": "864-609-7306",
            "fax_number": "864-609-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "JOE",
        "middle_name": "BRYAN",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-11",
        "last_updated": "2012-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "5549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylors, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; 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.