Healthcare Provider Details

I. General information

NPI: 1063432920
Provider Name (Legal Business Name): MOYES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 HUDSON BRIDGE RD
STOCKBRIDGE GA
30281-5038
US

IV. Provider business mailing address

1920 HUDSON BRIDGE RD
STOCKBRIDGE GA
30281-5038
US

V. Phone/Fax

Practice location:
  • Phone: 770-507-1234
  • Fax: 770-626-5059
Mailing address:
  • Phone: 770-507-1234
  • Fax: 770-626-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8280
License Number StateGA

VIII. Authorized Official

Name: LOREN B PIERCE
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 770-474-7693