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General NPI Number Information
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NPI Number | 1982976288
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Entity Type | Organization
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Legal Business Name | MOOSE PHARMACY OF KANNAPOLIS, INC
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 1113 N MAIN ST
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City | KANNAPOLIS
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State | NC
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Zip | 28081-2256
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Country | US
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Telephone | 704-932-9111
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Fax | 704-932-0197
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Provider Business Mailing Address
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Address Line | 1113 N MAIN ST
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City | KANNAPOLIS
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State | NC
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Zip | 28081-2256
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Country | US
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Telephone | 704-932-9111
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Fax | 704-932-0197
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Authorized Official
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Title or Position | TREASURER
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Name | KYLE YODER
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Credential |
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Telephone | 704-636-6340
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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 |
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License Number State |
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