NPIMap

Organization Active NPI

Moultrie Pharmacy at Langtown LLC

Doing business as Moultrie Pharmacy at Langtown

  • Community/Retail Pharmacy
  • Moulton, AL
National Provider Identifier
1366965576
Registry record updated Jul 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MOULTRIE PHARMACY AT LANGTOWN LLC
Doing business as
Moultrie Pharmacy at Langtown
Practice address
20332 Al Highway 33
Moulton, AL 35650-9204
Phone
(256) 566-3174
Fax
(256) 350-3366
NPI assigned
Jul 19, 2017
Last updated
Jul 19, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2017

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

Authorized official

Name
Dr. Benjamin David Moultrie, PHARMDNPI 1154943405
Title
Owner
Phone
(256) 566-3174

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

20332 Al Highway 33
Moulton, AL 35650-9204

Mailing address

1380 Old Highway 24
Trinity, AL 35673-5600
Phone (256) 566-3174

Other names 1

  • Moultrie Pharmacy at Langtown Doing business as

National Provider Directory

National Provider Directory

Locations

20332 AL Highway 33
Moulton, AL 35650
Phone (256) 566-3174

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500422400000",
    "number": "1366965576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 OLD HIGHWAY 24",
            "city": "TRINITY",
            "state": "AL",
            "postal_code": "356735600",
            "telephone_number": "256-566-3174",
            "fax_number": "256-350-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20332 AL HIGHWAY 33",
            "city": "MOULTON",
            "state": "AL",
            "postal_code": "356509204",
            "telephone_number": "256-566-3174",
            "fax_number": "256-350-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTRIE PHARMACY AT LANGTOWN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-19",
        "last_updated": "2017-07-19",
        "status": "A",
        "authorized_official_last_name": "MOULTRIE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-566-3174",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moultrie Pharmacy at Langtown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moulton, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2017; 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.