NPIMap

Organization Active NPI

McLeod Health Clarendon LTC Pharmacy

  • Pharmacy
  • Manning, SC
National Provider Identifier
1659360873
Registry record updated Feb 25, 2019
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Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
16726 Issued in SC
Legal business name
MCLEOD HEALTH CLARENDON LTC PHARMACY
Practice address
50 E Hospital St
Ste 1B
Manning, SC 29102-3149
Phone
(803) 435-5272
Fax
(803) 435-5271
NPI assigned
Oct 20, 2005
Last updated
Feb 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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

Authorized official

Name
Samuel Fulton Ervin III
Title
Sr VP and Cfo
Phone
(843) 777-2910

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 16726 SC Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

50 E Hospital St
Ste 1B
Manning, SC 29102-3149

Mailing address

50 E Hospital St
Ste 1B
Manning, SC 29102-3149
Phone (803) 435-5272

Other identifiers 2

IdentifierTypeStateIssuer
722205MedicaidSC
2163851OtherPK

Other names 1

  • Cypress Center LTC Pharmacy Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
McLeod Health Clarendon9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

50 E Hospital St
Ste 1B
Manning, SC 29102
Phone (803) 435-5272

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551052800000",
    "number": "1659360873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 E HOSPITAL ST",
            "address_2": "STE 1B",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023149",
            "telephone_number": "803-435-5272",
            "fax_number": "803-435-5271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E HOSPITAL ST",
            "address_2": "STE 1B",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023149",
            "telephone_number": "803-435-5272",
            "fax_number": "803-435-5271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD HEALTH CLARENDON LTC PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2005-10-20",
        "last_updated": "2019-02-25",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FULTON",
        "authorized_official_title_or_position": "SR VP AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "SC",
            "license": "16726",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "722205",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2163851",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cypress Center LTC Pharmacy",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Cypress Center LTC Pharmacy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Manning, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; 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.