Active NPI
Keturah Mingledolph, PHARMD
- Pharmacist
- Beech Island, SC
National Provider Identifier
1730817859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 43592
- Practice address
- 4295 Jefferson Davis Hwy
Beech Island, SC 29842-4824 - Phone
- (803) 593-5196
- NPI assigned
- Aug 9, 2022
- Last updated
- Aug 9, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 43592 | SC | Primary |
Addresses
Primary practice location
4295 Jefferson Davis Hwy
Beech Island, SC 29842-4824
Mailing address
4050 Brownstone Dr Apt 910
Evans, GA 30809-9133
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43592 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660003200000",
"number": "1730817859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4050 BROWNSTONE DR APT 910",
"city": "EVANS",
"state": "GA",
"postal_code": "308099133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4295 JEFFERSON DAVIS HWY",
"city": "BEECH ISLAND",
"state": "SC",
"postal_code": "298424824",
"telephone_number": "803-593-5196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINGLEDOLPH",
"first_name": "KETURAH",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-09",
"last_updated": "2022-08-09",
"certification_date": "2022-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "43592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beech Island, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.