Healthcare Provider Details

I. General information

NPI: 1780820605
Provider Name (Legal Business Name): ASHLEY LYNN MOOSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY BRANHAM

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E JEFFERSON ST
MONROE NC
28112
US

IV. Provider business mailing address

215 E JEFFERSON ST
MONROE NC
28112
US

V. Phone/Fax

Practice location:
  • Phone: 704-283-8131
  • Fax: 704-289-1954
Mailing address:
  • Phone: 704-436-9613
  • Fax: 704-436-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19578
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: