Moffettrx LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

03424-01MM Issued in MS

Legal business name

MOFFETTRX LLC

Practice address

2000 24TH Ave
Meridian, MS 39301-3120

Phone

(601) 693-0033

Fax

(601) 693-0062

NPI assigned

Jun 2, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Andrew Moffett, PHARMD

Title

Pharmacist in Charge/Owner

Phone

(601) 693-0033

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ole Towne Family Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Tax ID family

Hulls Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Moffettrx LLC

  • Long Term Care Pharmacy
  • Meridian, MS
  • NPI 1013631654
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1114929296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 24TH AVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393013120",
            "telephone_number": "601-693-0033",
            "fax_number": "601-693-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 24TH AVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393013120",
            "telephone_number": "601-693-0033",
            "fax_number": "601-693-0062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOFFETTRX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-02",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "MOFFETT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE/OWNER",
        "authorized_official_telephone_number": "601-693-0033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "03424-01MM",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "2518629",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330246",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ole Towne Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mobile Imaging, LLC
• Mobile Services, Inc
• Tanesha Mobley
• Katelyn Rebecca Moffett, FNP-C
• Moffettrx LLC
• Allyson Kale Monsour, MS, RD, LD
• Kayla Lee Monsour, PHARMD
• Derrick Monterey Moore Sr.
• Dorothy M Moore, HOMEMAKER
• Jennifer Ashley Moore, PHARMD

• All providers in Meridian, MS
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.