Healthcare Provider Details

I. General information

NPI: 1124060942
Provider Name (Legal Business Name): MOOSE DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
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: 704-792-2555
  • Fax: 704-789-9366
Mailing address:
  • Phone: 704-792-2555
  • Fax: 704-789-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09216
License Number StateNC

VIII. Authorized Official

Name: JOSEPH MOOSE
Title or Position: OWNER
Credential: PHARMD
Phone: 704-792-2555