Moose Pharmacy of Mt Holly LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

13746 Issued in NC

Legal business name

MOOSE PHARMACY OF MT HOLLY LLC

Doing business as

Moose Pharmacy of Mt. Holly

Practice address

125 W Central Ave
Mount Holly, NC 28120

Phone

(704) 827-2211

Fax

(704) 827-7134

NPI assigned

May 7, 2018

Organization subpart

No

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

Authorized official

Name

Kyle Yoder, PHARMD

Title

Manager

Phone

(704) 827-2211

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Moose Pharmacy of Mt. Holly Doing business as

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

Tax ID family

Moose Pharmacy of Mount Holly Long-Term Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Moose Pharmacy of Mt Holly LLC

  • Long Term Care Pharmacy
  • Mount Holly, NC
  • NPI 1720778442
  NPD tax ID

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526601600000",
    "number": "1437648334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 W CENTRAL AVE",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281201616",
            "telephone_number": "704-827-2211",
            "fax_number": "704-827-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W CENTRAL AVE",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "28120",
            "telephone_number": "704-827-2211",
            "fax_number": "704-827-7134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE PHARMACY OF MT HOLLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-07",
        "last_updated": "2018-05-18",
        "status": "A",
        "authorized_official_last_name": "YODER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "704-827-2211",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "13746",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2177554",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moose Pharmacy of Mt. Holly",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Moose Pharmacy of Mt. Holly",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caroline Hawkins McCumbee, DDS
• Miranda Rae-Tsukamoto McGahan, DO
• Sydney McGee
• MF Express Lab and Vitality Center
• Michael D Emmett
• Moose Pharmacy of Mt Holly LLC
• Nicole Kristine Morton, LCMHCA
• Mount Holly Dentistry
• Mount Holly Eye Clinic, OD, PA
• Mountain Island Charter School Inc

• Community/Retail Pharmacy in Mount Holly, NC
• Providers in Mount Holly, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; 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.