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General NPI Number Information
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NPI Number | 1043317027
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Entity Type | Organization
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Legal Business Name | MOOSE DRUG COMPANY
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 740 CHURCH ST N
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City | CONCORD
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State | NC
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Zip | 28025-4336
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Country | US
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Telephone | 704-784-9613
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Fax | 704-789-9366
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Provider Business Mailing Address
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Address Line | 740 CHURCH ST N
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City | CONCORD
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State | NC
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Zip | 28025-4336
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Country | US
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Telephone | 704-784-9613
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Fax | 704-784-9613
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH STEVEN MOOSE
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Credential | PHARMD
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Telephone | 704-784-9613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 05099
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License Number State | NC
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