Active NPI
Douglas Hansford Netterville
- Pharmacist
- Fountain Inn, SC
National Provider Identifier
1609475458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH-3585
- Practice address
- 248 Ivy Woods CT
Fountain Inn, SC 29644-9256 - Phone
- (901) 334-8542
- NPI assigned
- Oct 22, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | PH-3585 | SC | Primary |
Addresses
Primary practice location
248 Ivy Woods CT
Fountain Inn, SC 29644-9256
Mailing address
248 Ivy Woods CT
Fountain Inn, SC 29644-9256
Phone (901) 334-8542
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH-3585 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603324800000",
"number": "1609475458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 IVY WOODS CT",
"city": "FOUNTAIN INN",
"state": "SC",
"postal_code": "296449256",
"telephone_number": "901-334-8542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "248 IVY WOODS CT",
"city": "FOUNTAIN INN",
"state": "SC",
"postal_code": "296449256",
"telephone_number": "901-334-8542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NETTERVILLE",
"first_name": "DOUGLAS",
"middle_name": "HANSFORD",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-22",
"last_updated": "2020-10-22",
"certification_date": "2020-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "PH-3585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Inn, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.