Ted Tristan Nussbaum, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

11560 Issued in SC

Practice address

1008 Old Highway 52 Ste G
Moncks Corner, SC 29461-3011

Phone

(843) 899-4700

Fax

(843) 899-4702

NPI assigned

Feb 23, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Berkeley Home Pharmacy LLC

  • Community/Retail Pharmacy
  • Moncks Corner, SC
  • NPI 1508223645
  NPD Authorized official
• Walgreen Co

  • Pharmacy
  • Moncks Corner, SC
  • NPI 1790894061
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1497052666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 OLD HIGHWAY 52 STE G",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613011",
            "telephone_number": "843-830-8640",
            "fax_number": "843-899-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 OLD HIGHWAY 52 STE G",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613011",
            "telephone_number": "843-899-4700",
            "fax_number": "843-899-4702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUSSBAUM",
        "first_name": "TED",
        "middle_name": "TRISTAN",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-23",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "11560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leanne M North
• Nu South Providers
• Marissa Nicole Nunes-Bryant, BSN, RN
• Nurturing Wonders
• Noah Davis Nussbaum, PHARMD
• Oasis Christian Counseling, Inc
• Melissa A Oconnor
• Ohio Valley Physicians, Inc
• Deia Oliver-Dixon
• Jessica I. Oliver, LISW-CP

• Pharmacist in Moncks Corner, SC
• Providers in Moncks Corner, SC by specialty
• Pharmacist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; 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.