Active NPI
Medicine Mart of Gaffney
- Community/Retail Pharmacy
- Gaffney, SC
National Provider Identifier
1679670517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 17352
- Legal business name
- MEDICINE MART OF GAFFNEY
- Practice address
- 305 N Limestone St
Gaffney, SC 29340-3171 - Phone
- (864) 489-5198
- Fax
- (864) 488-9297
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Roy Flynn
- Title
- VP
- Phone
- (803) 968-7000
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 17352 | SC | Primary |
Addresses
Primary practice location
305 N Limestone St
Gaffney, SC 29340-3171
Mailing address
305 N Limestone St
Gaffney, SC 29340-3171
Phone (864) 489-5198
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2170367 | Other | PK | |
| 717352 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190409000773 | SC | Part B Supplier - Mass Immunization (Roster Biller Only) | 4587905179 | Practice locations: Gaffney, SC |
National Provider Directory
National Provider DirectoryLocations
305 N Limestone St
Gaffney, SC 29340
Phone (864) 489-5198
305 N Limestone St
Ste A
Gaffney, SC 29340
Phone (704) 419-9878
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Gaffney, SC
- NPI 1982126066
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1721779200000",
"number": "1679670517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 N LIMESTONE ST",
"city": "GAFFNEY",
"state": "SC",
"postal_code": "293403171",
"telephone_number": "864-489-5198",
"fax_number": "864-488-9297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 N LIMESTONE ST",
"city": "GAFFNEY",
"state": "SC",
"postal_code": "293403171",
"telephone_number": "864-489-5198",
"fax_number": "864-488-9297"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDICINE MART OF GAFFNEY",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-20",
"last_updated": "2024-07-24",
"certification_date": "2024-07-24",
"status": "A",
"authorized_official_last_name": "FLYNN",
"authorized_official_first_name": "ROY",
"authorized_official_title_or_position": "VP",
"authorized_official_telephone_number": "803-968-7000"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "SC",
"license": "17352",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2170367",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "717352",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Gaffney, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.