NPIMap

Organization Active NPI

Med Mart Weco LLC

Doing business as Medicine Mart of West Columbia

  • Community/Retail Pharmacy
  • West Columbia, SC
National Provider Identifier
1598858987
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MED MART WECO LLC
Doing business as
Medicine Mart of West Columbia
Practice address
1300 Sunset Blvd
West Columbia, SC 29169-5914
Phone
(803) 791-7043
Fax
(803) 796-1519
NPI assigned
Sep 30, 2006
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Michael Adam GleatonNPI 1265821755
Title
Owner
Phone
(803) 957-5969

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1300 Sunset Blvd
West Columbia, SC 29169-5914

Mailing address

1300 Sunset Blvd
West Columbia, SC 29169-5914
Phone (803) 791-7043

Other identifiers 1

IdentifierTypeStateIssuer
717584MedicaidSC

Other names 1

  • MEDICINE MART OF WEST COLUMBIA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061206000361 SC Part B Supplier - Mass Immunization (Roster Biller Only) 9638178320 Practice locations: West Columbia, SC
O20250209000018 SC Part B Supplier - Pharmacy 4486184264 Practice locations: West Columbia, SC

National Provider Directory

National Provider Directory
Tax ID family
Med Mart Weco LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1598858987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 SUNSET BLVD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291695914",
            "telephone_number": "803-791-7043",
            "fax_number": "803-796-1519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 SUNSET BLVD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291695914",
            "telephone_number": "803-791-7043",
            "fax_number": "803-796-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED MART WECO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-30",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "GLEATON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-957-5969"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "717584",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE MART OF WEST COLUMBIA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; 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.