Pontiac Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

50009706 Issued in SC

Legal business name

PONTIAC PHARMACY

Practice address

10535 A Two Notch Rd
Elgin, SC 29045

Phone

(803) 865-0099

Fax

(803) 865-0098

NPI assigned

Oct 19, 2007

Last updated

Nov 14, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brian Duffie

Title

Phcy Mang

Phone

(803) 865-0099

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1962691592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10535 A TWO NOTCH RD",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "29045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10535 A TWO NOTCH RD",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "29045",
            "telephone_number": "803-865-0099",
            "fax_number": "803-865-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONTIAC PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "DUFFIE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PHCY MANG",
        "authorized_official_telephone_number": "803-865-0099"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "50009706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "4227422",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Elgin, SC
• Providers in Elgin, SC by specialty
• Community/Retail Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; 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.