Williamston Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

WILLIAMSTON PHARMACY LLC

Practice address

10 N Hamilton St
Williamston, SC 29697-1536

Phone

(864) 301-8441

NPI assigned

Apr 7, 2021

Organization subpart

No

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

Authorized official

Name

Michael Deserio

Title

Manager

Phone

(864) 301-8441

Specialties & licenses 1

Addresses

Other names 1

• Vistara Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1396324059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 N HAMILTON ST",
            "city": "WILLIAMSTON",
            "state": "SC",
            "postal_code": "296971536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N HAMILTON ST",
            "city": "WILLIAMSTON",
            "state": "SC",
            "postal_code": "296971536",
            "telephone_number": "864-301-8441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSTON PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "DESERIO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "864-301-8441"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vistara Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Walgreen Co
• James Christian Williams, MD
• Marion K Williams, OPTOMETRIST
• Mary Williams, RN
• Williamston Family Dental, LLC
• Williamston Rescue Squad
• Melodie Abel Wilson, PHARMACIST
• Jack D Wise Jr., DC
• Marylouise Schultz Wise, DC

• Community/Retail Pharmacy in Williamston, SC
• Providers in Williamston, 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 Apr 7, 2021; 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.