Active NPI
Sergio Montes, PHARMACIST
- Pharmacist
- Lake City, SC
National Provider Identifier
1376954305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12390
- Practice address
- 900 US Hwy 52
Lake City, SC 29560 - Phone
- (843) 394-8125
- Fax
- (843) 394-8303
- NPI assigned
- May 13, 2014
- Last updated
- May 13, 2014
- Sex
- Male
- Sole proprietor
- No
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 | 12390 | SC | Primary |
Addresses
Primary practice location
900 US Hwy 52
Lake City, SC 29560
Mailing address
900 Hwy 52
Lake City, SC 29560
Phone (843) 394-8125
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12390 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Walmart Pharmacy 10-0621
- Community/Retail Pharmacy
- Lake City, SC
- NPI 1386661544
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399939200000",
"number": "1376954305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 HWY 52",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "29560",
"telephone_number": "843-394-8125",
"fax_number": "843-394-8303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 US HWY 52",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "29560",
"telephone_number": "843-394-8125",
"fax_number": "843-394-8303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTES",
"first_name": "SERGIO",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-13",
"last_updated": "2014-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "12390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.