Healthcare Provider Details

I. General information

NPI: 1396981239
Provider Name (Legal Business Name): MOOSE DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8374 WEST FRANKLIN STREET
MOUNT PLEASANT NC
28124-0067
US

IV. Provider business mailing address

8374 WEST FRANKLIN STREET PO BOX 67
MOUNT PLEASANT NC
28124-0067
US

V. Phone/Fax

Practice location:
  • Phone: 704-436-9613
  • Fax: 704-436-6512
Mailing address:
  • Phone: 704-436-9613
  • Fax: 704-436-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05395
License Number StateNC

VIII. Authorized Official

Name: JAMES BOWMAN
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 704-436-9613