Wall Drugs of Pamplico, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

WALL DRUGS OF PAMPLICO, INC.

Practice address

616 S. Walnut Street
Pamplico, SC 29583

Phone

(843) 933-0080

NPI assigned

Jul 1, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Derrick Allan Wall

Title

RPH, Owner

Phone

(843) 386-6135

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kellie White Douglas, PHARM.D

  • Pharmacist
  • Pamplico, SC
  • NPI 1821465964
  NPD
• April E Newell, PHARMD

  • Pharmacist
  • Johnsonville, SC
  • NPI 1023109154
  NPD (past)

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

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613088000000",
    "number": "1639796022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 240",
            "city": "JOHNSONVILLE",
            "state": "SC",
            "postal_code": "295550240",
            "telephone_number": "843-905-0200",
            "fax_number": "843-905-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 S. WALNUT STREET",
            "city": "PAMPLICO",
            "state": "SC",
            "postal_code": "29583",
            "telephone_number": "843-933-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALL DRUGS OF PAMPLICO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-01",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "RPH, OWNER",
        "authorized_official_telephone_number": "843-386-6135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lavon Cain Pinder, M.A. LPC
• Brandie Andrews Reynolds, M.D.
• James David Robinson, MA
• Tamiquia Simon, ED.D
• Theresa'S Way
• Sandra Weatherford, FNP

• Community/Retail Pharmacy in Pamplico, SC
• Providers in Pamplico, 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 Feb 12, 2021; 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.