Active NPI
Nicole Elizabeth Kennedy, PHARMD
- Pharmacist
- Sumter, SC
National Provider Identifier
1427569987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 37399
- Practice address
- 343 Pinewood Rd
Sumter, SC 29150-5442 - Phone
- (803) 305-6237
- NPI assigned
- Oct 23, 2017
- Last updated
- May 5, 2019
- 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 | 37399 | SC | Primary |
Addresses
Primary practice location
343 Pinewood Rd
Sumter, SC 29150-5442
Mailing address
345 Edenwood Dr
Sumter, SC 29154-8141
Phone (803) 464-2050
Other practice location 1
615 Bultman Dr
Sumter, SC 29150-2514
Phone (803) 305-6194
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427569987 | Other | SC | NPI |
| 37399 | Other | SC | SC PHARMACY 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 |
|---|---|---|---|
| 37399 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past | Accepting new patients | |
| Wal-Mart Stores East LP | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Walmart Pharmacy 10-5383
- Community/Retail Pharmacy
- Sumter, SC
- NPI 1730558024
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557014400000",
"number": "1427569987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 EDENWOOD DR",
"city": "SUMTER",
"state": "SC",
"postal_code": "291548141",
"telephone_number": "803-464-2050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "343 PINEWOOD RD",
"city": "SUMTER",
"state": "SC",
"postal_code": "291505442",
"telephone_number": "803-305-6237"
}
],
"practiceLocations": [
{
"address_1": "615 Bultman Dr",
"address_purpose": "LOCATION",
"city": "Sumter",
"state": "SC",
"postal_code": "291502514",
"country_code": "US",
"telephone_number": "803-305-6194",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KENNEDY",
"first_name": "NICOLE",
"middle_name": "ELIZABETH",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-23",
"last_updated": "2019-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "37399",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1427569987",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC PHARMACY LICENSE",
"identifier": "37399",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sumter, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.