Active NPI
Marissa Wallin, PHARMD
- Pharmacist
- Sumter, SC
National Provider Identifier
1851949564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 42095
- Practice address
- 1080 Alice Dr
Sumter, SC 29150-2463 - Phone
- (803) 778-0460
- NPI assigned
- Aug 27, 2019
- 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 | 42095 | SC | Primary |
Addresses
Primary practice location
1080 Alice Dr
Sumter, SC 29150-2463
Mailing address
239 Keels Rd
Sumter, SC 29154-4619
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42095 | Other | SC | PHARMACY |
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 |
|---|---|---|---|
| 42095 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566864000000",
"number": "1851949564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 KEELS RD",
"city": "SUMTER",
"state": "SC",
"postal_code": "291544619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1080 ALICE DR",
"city": "SUMTER",
"state": "SC",
"postal_code": "291502463",
"telephone_number": "803-778-0460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLIN",
"first_name": "MARISSA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-27",
"last_updated": "2019-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "42095",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY",
"identifier": "42095",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sumter, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.