Healthcare Provider Details

I. General information

NPI: 1689610594
Provider Name (Legal Business Name): MOSELEY DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 JOHNSON ST. SE
DAWSON GA
39842-1523
US

IV. Provider business mailing address

P.O. BOX 5
DAWSON GA
39842
US

V. Phone/Fax

Practice location:
  • Phone: 229-995-2126
  • Fax: 229-995-3042
Mailing address:
  • Phone: 229-995-2126
  • Fax: 229-995-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE006813
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA LYNN MARTIN
Title or Position: OWNER/PHARMACIST
Credential: PHARM.D.
Phone: 229-995-2126