Heisalive,LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

HEISALIVE,LLC

Practice address

723 Bethel St
Clover, SC 29710-1157

Phone

(803) 222-6060

Fax

(803) 222-6074

NPI assigned

May 8, 2023

Organization subpart

No

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

Authorized official

Name

Anita Zola Dowdy

Title

Owner

Phone

(843) 479-7101

Specialties & licenses 1

Addresses

Other names 1

• MEDCARE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Johnny Jay Horace, R.PH

  • Pharmacist
  • Clover, SC
  • NPI 1821302993
  NPD

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1831889526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 COTTINGHAM BLVD N STE B",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295122856",
            "telephone_number": "843-479-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 BETHEL ST",
            "city": "CLOVER",
            "state": "SC",
            "postal_code": "297101157",
            "telephone_number": "803-222-6060",
            "fax_number": "803-222-6074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEISALIVE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-08",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A",
        "authorized_official_last_name": "DOWDY",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "ZOLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-479-7101"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDCARE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEDCARE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Thomas Wesley Hartlage, PT, DPT
• Edward Lawson Held, MD
• Elijah Nathaniel Helm, BSW, MSW, LCSW(A)
• Jonathan Bennett Hixson, DPT
• Michael James Holtel, RPH
• Johnny Jay Horace, R.PH

• All providers in Clover, SC
• Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.