Active NPI
Mica Lauren Blackmon, PHARM.D.
- Pharmacist
- Kershaw, SC
National Provider Identifier
1417205709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13860
- Practice address
- 515 S Hampton St
Kershaw, SC 29067-1834 - Phone
- (803) 475-7370
- NPI assigned
- Aug 17, 2012
- Last updated
- Feb 20, 2021
- Sex
- Female
- 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 | 13860 | SC | Primary |
Addresses
Primary practice location
515 S Hampton St
Kershaw, SC 29067-1834
Mailing address
515 S Hampton St
Kershaw, SC 29067-1834
Phone (803) 475-7370
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 |
|---|---|---|---|
| 13860 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613779200000",
"number": "1417205709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 S HAMPTON ST",
"city": "KERSHAW",
"state": "SC",
"postal_code": "290671834",
"telephone_number": "803-475-7370",
"fax_number": "803-475-5531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 S HAMPTON ST",
"city": "KERSHAW",
"state": "SC",
"postal_code": "290671834",
"telephone_number": "803-475-7370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKMON",
"first_name": "MICA",
"middle_name": "LAUREN",
"name_prefix": "Mrs.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-17",
"last_updated": "2021-02-20",
"certification_date": "2021-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "13860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kershaw, SC
- Elizabeth Anderson
- Florence Lamb Arnold
- Codrington Banda, EDS, MA, LPC-A
- Darlinda K. Banda, EDS, MA, LPC, NCC
- Randall Stewart Barre, MD
- Lynzi Rena Branham, APRN
- Jessica Brubeck, NP
- C.L. Thaxton Insurance Group, Inc. (Thaxton Insurance Group)
- Care-Net of Lancaster (Plexus Health)
- Carolina Behavioral Healthcare LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.