NPIMap

Organization Active NPI

Mooresville Pharmacy East, LLC

  • Long Term Care Pharmacy
  • Mooresville, NC
National Provider Identifier
1245707116
Registry record updated Oct 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
MOORESVILLE PHARMACY EAST, LLC
Practice address
594 N Main St
Mooresville, NC 28115-2328
Phone
(704) 799-6870
NPI assigned
Oct 30, 2018
Organization subpart
Yes
Parent organization
MOORESVILLE PHARMACY EAST LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2018

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

Authorized official

Name
Gavin Michael Houchins, PHARM.D
Title
Owner
Phone
(704) 799-6872

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

594 N Main St
Mooresville, NC 28115-2328

Mailing address

594 N Main St
Mooresville, NC 28115-2328
Phone (704) 799-6870

Other identifiers 2

IdentifierTypeStateIssuer
0497129MedicaidNC
7N7707MedicaidSC

Other names 1

  • HEALTHSMART PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Healthsmart Pharmacy4 organizations share this tax ID, including this one
Part of
Healthsmart Pharmacy

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540857600000",
    "number": "1245707116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "594 N MAIN ST",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152328",
            "telephone_number": "704-799-6870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "594 N MAIN ST",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152328",
            "telephone_number": "704-799-6870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PHARMACY EAST, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOORESVILLE PHARMACY EAST LLC",
        "enumeration_date": "2018-10-30",
        "last_updated": "2018-10-30",
        "status": "A",
        "authorized_official_last_name": "HOUCHINS",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-799-6872",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0497129",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7N7707",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEALTHSMART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.