MD Moulton LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH26299 Issued in FL

Legal business name

MD MOULTON LLC

Doing business as

Mike's Pharmacy

Practice address

8400 Astronaut Blvd
Cape Canaveral, FL 32920-4302

Phone

(321) 783-7883

Fax

(321) 783-7889

NPI assigned

Sep 6, 2012

Organization subpart

No

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

Authorized official

Name

Michael MoultonNPI 1558614354

Title

Owner/Pharmacist

Phone

(321) 783-7883

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mike's Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael D Moulton, PHARMD, RPH

  • Pharmacist
  • Cape Canaveral, FL
  • NPI 1558614354
  NPD (past) Authorized official

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

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360627200000",
    "number": "1336498377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 ASTRONAUT BLVD",
            "city": "CAPE CANAVERAL",
            "state": "FL",
            "postal_code": "329204302",
            "telephone_number": "321-783-7883",
            "fax_number": "321-783-7889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 ASTRONAUT BLVD",
            "city": "CAPE CANAVERAL",
            "state": "FL",
            "postal_code": "329204302",
            "telephone_number": "321-783-7883",
            "fax_number": "321-783-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD MOULTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-06",
        "last_updated": "2013-02-12",
        "status": "A",
        "authorized_official_last_name": "MOULTON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "321-783-7883"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006742800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5711660",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mike's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Reneau Lovell, LPN
• Melissa Ann Lyon
• Casandra Marino
• Jennifer Marquez
• Denise Michelle McBroom, PA
• Joseph John Mignogna, MD
• Amy Miller, CNA
• Moa Miami LLC
• Johnny Joseph Morales, LAT, ATC
• Michael D Moulton, PHARMD, RPH

• Community/Retail Pharmacy in Cape Canaveral, FL
• Providers in Cape Canaveral, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; 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.