Provider Demographics
NPI:1033497664
Name:MEDICATION THERAPY MANAGEMENT SYSTEMS, LLC
Entity Type:Organization
Organization Name:MEDICATION THERAPY MANAGEMENT SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/SUPERVISING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TOUSSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-767-1023
Mailing Address - Street 1:1504 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1414
Mailing Address - Country:US
Mailing Address - Phone:803-767-1023
Mailing Address - Fax:
Practice Address - Street 1:1504 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1414
Practice Address - Country:US
Practice Address - Phone:803-767-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC123031835P0018X
GA246251835P0018X
NC202861835P0018X
SC32405207T00000X
SC619213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1720287816Medicaid
SC1811289044OtherNPPES