Berkeley Home Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

16354 Issued in SC

Legal business name

BERKELEY HOME PHARMACY LLC

Doing business as

Berkeley Home Pharmacy

Practice address

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

Phone

(843) 899-4700

Fax

(843) 899-4702

NPI assigned

Jan 20, 2016

Last updated

Jun 10, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ted Tristan Nussbaum, RPHNPI 1497052666

Title

Owner/Pharmacist

Phone

(843) 899-4700

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Berkeley Home Pharmacy Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ted Tristan Nussbaum, RPH

  • Pharmacist
  • Moncks Corner, SC
  • NPI 1497052666
  NPD Authorized official
• Noah Davis Nussbaum, PHARMD

  • Pharmacist
  • Moncks Corner, SC
  • NPI 1023905759
  NPD

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

{
    "created_epoch": "1453248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1508223645",
    "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": "843-899-4700",
            "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": {
        "organization_name": "BERKELEY HOME PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-20",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "NUSSBAUM",
        "authorized_official_first_name": "TED",
        "authorized_official_middle_name": "TRISTAN",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "843-899-4700",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "16354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "716354",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2157670",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkeley Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Berkeley Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Berkeley County School District
• Berkeley County Schools
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• Berkeley Family Practice LLC
• Berkeley Home Clinic
• Berkeley Medical Center, LLC
• Berkeley Prosthetic Laboratory LLC
• Berkeley Seniors Inc
• Berkeley Treatment Center LLC
• Erin M Berkey, LPC

• Community/Retail Pharmacy in Moncks Corner, SC
• Providers in Moncks Corner, 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 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.