Active NPI
Timothy Michael Ellis, PHARMD
- Pharmacist
- Simpsonville, SC
National Provider Identifier
1790040863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13922
- Practice address
- 26 Laurelhart LN
Simpsonville, SC 29281-3909 - Phone
- (864) 714-9899
- NPI assigned
- Jul 5, 2012
- Last updated
- Oct 3, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13922 | SC | Primary |
| Pharmacist | 183500000X | 22700 | NC |
Addresses
Primary practice location
26 Laurelhart LN
Simpsonville, SC 29281-3909
Mailing address
26 Laurelhart Lane
Simpsonville, SC 29681
Phone (864) 714-9899
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 |
|---|---|---|---|
| 22700 | NC | MD | Pharmacist |
| 13922 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633219200000",
"number": "1790040863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 LAURELHART LANE",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "29681",
"telephone_number": "864-714-9899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 LAURELHART LN",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "292813909",
"telephone_number": "864-714-9899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "TIMOTHY",
"middle_name": "MICHAEL",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-05",
"last_updated": "2021-10-03",
"certification_date": "2021-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "13922",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "22700",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Simpsonville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.