NPIMap

Organization Active NPI

Peacock Pharmacy LLC

  • Community/Retail Pharmacy
  • Spartanburg, SC
National Provider Identifier
1699086546
Registry record updated Jul 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PEACOCK PHARMACY LLC
Doing business as
Peacock Pharmacy LLC
Practice address
8147 Warren H Abernathy Hwy
Spartanburg, SC 29301-2451
Phone
(864) 587-5707
NPI assigned
Jun 25, 2010
Last updated
Jul 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2010

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

Authorized official

Name
Adam Wellington
Title
President
Phone
(423) 547-3224

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary
Mail Order Pharmacy 3336M0002X NU

Addresses

Primary practice location

8147 Warren H Abernathy Hwy
Spartanburg, SC 29301-2451

Mailing address

1201 Hwy 19E Byass
Suite 3
Ellizabethton, TN 37649
Phone (423) 547-3224

Other identifiers 1

IdentifierTypeStateIssuer
4229731OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Peacock Pharmacy LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peacock Pharmacy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

8147 Warren H Abernathy Hwy
Spartanburg, SC 29301
Phone (864) 587-1001

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279238400000",
    "number": "1699086546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 HWY 19E BYASS",
            "address_2": "SUITE 3",
            "city": "ELLIZABETHTON",
            "state": "TN",
            "postal_code": "37649",
            "telephone_number": "423-547-3224",
            "fax_number": "800-419-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8147 WARREN H ABERNATHY HWY",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293012451",
            "telephone_number": "864-587-5707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-25",
        "last_updated": "2010-07-16",
        "status": "A",
        "authorized_official_last_name": "WELLINGTON",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-547-3224"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4229731",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peacock Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2010; 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.