NPIMap

Organization Active NPI

Crocodile Pharmacy Services, LLC

Doing business as CP-Blythewood

  • Internal Medicine Physician
  • Blythewood, SC
National Provider Identifier
1780217208
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CROCODILE PHARMACY SERVICES, LLC
Doing business as
CP-Blythewood
Practice address
738 University Village Dr
Blythewood, SC 29016-7611
Phone
(480) 235-7788
NPI assigned
Feb 13, 2020
Last updated
Feb 13, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CROCODILE PHARMACY SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Authorized official

Name
Dr. Paul Plante, MD
Title
Medical Director
Phone
(803) 730-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

738 University Village Dr
Blythewood, SC 29016-7611

Mailing address

9005 Two Notch Rd
Ste 40
Columbia, SC 29223-5850
Phone (480) 235-7788

Other names 1

  • CP-Blythewood Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Crocodile Pharmacy Services LLC4 organizations share this tax ID, including this one
Part of
Crocodile Pharmacy Services LLC

Other organizations with this tax ID 3

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

Locations

738 University Village Dr
Blythewood, SC 29016
Phone (803) 461-0270

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1780217208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9005 TWO NOTCH RD",
            "address_2": "STE 40",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292235850",
            "telephone_number": "480-235-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 UNIVERSITY VILLAGE DR",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290167611",
            "telephone_number": "480-235-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROCODILE PHARMACY SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROCODILE PHARMACY SERVICES, LLC",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "PLANTE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "803-730-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CP-Blythewood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blythewood, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.