NPIMap

Individual provider Active NPI

Venice Matawaran

  • Pharmacist
  • Greenville, SC
National Provider Identifier
1679892228
Registry record updated Feb 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
11172 Issued in SC
Practice address
2616 Anderson Rd
Greenville, SC 29611-6020
Phone
(864) 537-4062
NPI assigned
May 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 11172 SC Primary

Addresses

Primary practice location

2616 Anderson Rd
Greenville, SC 29611-6020

Mailing address

2616 Anderson Rd
Greenville, SC 29611-6020

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

LicenseStateTypeSpecialty
11172SCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co CurrentSince Jan 1, 2023 Accepting new patients
Walgreen Co PastSince Jan 1, 2023 Accepting new patients
Eckerd Corporation Past Accepting new patients

Locations

2616 Anderson Rd
Greenville, SC 29611
Phone (864) 537-4062

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1274400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1679892228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2616 ANDERSON RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296116020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2616 ANDERSON RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296116020",
            "telephone_number": "864-537-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATAWARAN",
        "first_name": "VENICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-21",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "11172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; 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.