Healthcare Provider Details

I. General information

NPI: 1043236524
Provider Name (Legal Business Name): MOON'S DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E MAIN ST
WESTMINSTER SC
29693-1753
US

IV. Provider business mailing address

132 E MAIN ST
WESTMINSTER SC
29693-1753
US

V. Phone/Fax

Practice location:
  • Phone: 864-647-8770
  • Fax: 864-647-2906
Mailing address:
  • Phone: 864-647-8770
  • Fax: 864-647-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number037117538
License Number StateSC

VIII. Authorized Official

Name: MR. JERRY LEE SMITH
Title or Position: PRES./OWNER
Credential: RPH
Phone: 864-647-8770