Healthcare Provider Details

I. General information

NPI: 1043317027
Provider Name (Legal Business Name): MOOSE DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 CHURCH ST N
CONCORD NC
28025-4336
US

IV. Provider business mailing address

740 CHURCH ST N
CONCORD NC
28025-4336
US

V. Phone/Fax

Practice location:
  • Phone: 704-784-9613
  • Fax: 704-789-9366
Mailing address:
  • Phone: 704-784-9613
  • Fax: 704-784-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05099
License Number StateNC

VIII. Authorized Official

Name: DR. JOSEPH STEVEN MOOSE
Title or Position: OWNER
Credential: PHARMD
Phone: 704-784-9613