Healthcare Provider Details

I. General information

NPI: 1043900954
Provider Name (Legal Business Name): MOOSE DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8374 W FRANKLIN ST
MT PLEASANT NC
28124-8812
US

IV. Provider business mailing address

8374 W FRANKLIN ST
MT PLEASANT NC
28124-8812
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM WHITAKER MOOSE
Title or Position: PHARMACY OWNER
Credential:
Phone: 704-436-9613