Organization Active NPI

Medicine Mart of Gaffney

  • Community/Retail Pharmacy
  • Gaffney, SC
National Provider Identifier
1679670517
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
17352 Issued in SC
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

Updated by the provider on Jul 24, 2024

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
2170367OtherPK
717352MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190409000773 SC Part B Supplier - Mass Immunization (Roster Biller Only) 4587905179 Practice locations: Gaffney, SC

National Provider Directory

National Provider Directory

Locations

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.

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.

Verify at the official NPI Registry.