NPIMap

Organization Active NPI

Mooresville Pharmacy East LLC

  • Community/Retail Pharmacy
  • Mooresville, NC
National Provider Identifier
1336222801
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MOORESVILLE PHARMACY EAST LLC
Practice address
594 N Main St
Mooresville, NC 28115-2328
Phone
(704) 799-6870
Fax
(704) 799-6871
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Dr. Gavin Michael Houchins
Title
Owner Pharmacist
Phone
(704) 799-6870

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 7707 NC
Community/Retail Pharmacy 3336C0003X Primary
Long Term Care Pharmacy 3336L0003X 07707 NC

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 4

IdentifierTypeStateIssuer
0497129MedicaidNC
3438276OtherOTHER ID NUMBER-COMMERCIAL NUMBER
7N7707MedicaidSC
7703285MedicaidNC

Other names 1

  • HealthSmart Pharmacy (East) Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070327000746 NC Part B Supplier - Mass Immunization (Roster Biller Only) 7911001185 Practice locations: Mooresville, NC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1336222801",
    "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",
            "fax_number": "704-799-6871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PHARMACY EAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "HOUCHINS",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER PHARMACIST",
        "authorized_official_telephone_number": "704-799-6870",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "7707",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NC",
            "license": "07707",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0497129",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3438276",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7N7707",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7703285",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSmart Pharmacy (East)",
            "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 Mar 7, 2023; 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.