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General NPI Number Information
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NPI Number | 1922118769
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Entity Type | Organization
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Legal Business Name | MOON'S PHARMACY LTC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 711 2ND ST W
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City | TIFTON
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State | GA
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Zip | 31794-4201
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Country | US
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Telephone | 229-256-0139
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Fax | 229-256-0140
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Provider Business Mailing Address
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Address Line | 717 B W 2ND ST
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-382-3711
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Fax | 229-387-7521
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE M. MARAMAN
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Credential | PHARMD
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Telephone | 229-382-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHRE008877
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License Number State | GA
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