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General NPI Number Information
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NPI Number | 1356628937
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Entity Type | Organization
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Legal Business Name | MOORESVILLE PHARMACY EAST, LLC
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 439 E STATESVILLE AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-2533
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Country | US
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Telephone | 704-799-6870
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Fax | 704-799-6871
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Provider Business Mailing Address
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Address Line | 439 E STATESVILLE AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-2533
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Country | US
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Telephone | 704-799-6870
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Fax | 704-799-6871
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. GAVIN HOUCHINS
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Credential |
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Telephone | 704-799-6870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 07707
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License Number State |
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