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General NPI Number Information
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NPI Number | 1366597270
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Entity Type | Organization
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Legal Business Name | MOON'S DRUG STORE, INC.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 132 E MAIN ST
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City | WESTMINSTER
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State | SC
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Zip | 29693-1753
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Country | US
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Telephone | 864-647-5941
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Fax | 864-647-2906
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Provider Business Mailing Address
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Address Line | 132 E MAIN ST
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City | WESTMINSTER
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State | SC
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Zip | 29693-1753
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Country | US
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Telephone | 864-647-5941
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Fax | 864-647-2906
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Authorized Official
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Title or Position | OWNER/RPH
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Name | JERRY L SMITH
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Credential |
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Telephone | 864-647-5941
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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 | 50002242
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License Number State | SC
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