NPIMap

Organization Active NPI

Mooresville Pharmacy East, LLC

  • Specialty Pharmacy
  • Mooresville, NC
National Provider Identifier
1356628937
Registry record updated Nov 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
License
07707
Legal business name
MOORESVILLE PHARMACY EAST, LLC
Practice address
439 E Statesville Ave
Mooresville, NC 28115-2533
Phone
(704) 799-6870
Fax
(704) 799-6871
NPI assigned
Nov 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2011

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

Authorized official

Name
Dr. Gavin Houchins
Title
Owner/Manager
Phone
(704) 799-6870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialty Pharmacy 3336S0011X 07707 Primary

Addresses

Primary practice location

439 E Statesville Ave
Mooresville, NC 28115-2533

Mailing address

439 E Statesville Ave
Mooresville, NC 28115-2533
Phone (704) 799-6870

Other identifiers 1

IdentifierTypeStateIssuer
0497129MedicaidNC

National Provider Directory

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

Other organizations with this tax ID 3

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

Locations

439 E Statesville Ave
Mooresville, NC 28115
Phone (704) 799-6870

NPI Registry JSON

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

{
    "created_epoch": "1320796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320796800000",
    "number": "1356628937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "439 E STATESVILLE AVE",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152533",
            "telephone_number": "704-799-6870",
            "fax_number": "704-799-6871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 E STATESVILLE AVE",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152533",
            "telephone_number": "704-799-6870",
            "fax_number": "704-799-6871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PHARMACY EAST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-09",
        "last_updated": "2011-11-09",
        "status": "A",
        "authorized_official_last_name": "HOUCHINS",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "704-799-6870",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": "07707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0497129",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Nov 9, 2011; 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.