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General NPI Number Information
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NPI Number | 1689610594
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Entity Type | Organization
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Legal Business Name | MOSELEY DRUG COMPANY INC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 412 JOHNSON ST. SE
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City | DAWSON
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State | GA
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Zip | 39842-1523
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Country | US
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Telephone | 229-995-2126
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Fax | 229-995-3042
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Provider Business Mailing Address
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Address Line | P.O. BOX 5
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City | DAWSON
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State | GA
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Zip | 39842
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Country | US
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Telephone | 229-995-2126
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Fax | 229-995-3042
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DR. AMANDA LYNN MARTIN
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Credential | PHARM.D.
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Telephone | 229-995-2126
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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 | PHRE006813
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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