Healthcare Provider Details

I. General information

NPI: 1205915626
Provider Name (Legal Business Name): MOYES DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E RAILROAD ST SE
PELHAM GA
31779-2235
US

IV. Provider business mailing address

162 E RAILROAD ST SE
PELHAM GA
31779-2235
US

V. Phone/Fax

Practice location:
  • Phone: 229-294-4058
  • Fax: 229-294-1134
Mailing address:
  • Phone: 229-294-4058
  • Fax: 229-294-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE005984
License Number StateGA

VIII. Authorized Official

Name: HAYDEN MOYE
Title or Position: PRES/CEO
Credential:
Phone: 229-294-4058