Active NPI
Timothy Vannatta
- Pharmacist
- Summerville, SC
National Provider Identifier
1972964963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 39501
- Practice address
- 626 Bacons Bridge Rd
Summerville, SC 29485-4102 - Phone
- (843) 873-5830
- Fax
- (843) 873-8742
- NPI assigned
- Mar 17, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 39501 | SC | Primary |
| Pharmacist | 183500000X | 051036205 | IL | |
| Pharmacist | 183500000X | 320 | VI |
Addresses
Primary practice location
626 Bacons Bridge Rd
Summerville, SC 29485-4102
Mailing address
626 Bacons Bridge Rd
Summerville, SC 29485-4102
Phone (843) 873-5830
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051036205 | IL | MD | Pharmacist |
| 39501 | SC | MD | Pharmacist |
| 320 | VI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458172800000",
"number": "1972964963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 BACONS BRIDGE RD",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294854102",
"telephone_number": "843-873-5830",
"fax_number": "843-873-8742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "626 BACONS BRIDGE RD",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294854102",
"telephone_number": "843-873-5830",
"fax_number": "843-873-8742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANNATTA",
"first_name": "TIMOTHY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-17",
"last_updated": "2016-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "39501",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051036205",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VI",
"license": "320",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.