Active NPI
Mooresville Pharmacy LLC
- Community/Retail Pharmacy
- Mooresville, NC
National Provider Identifier
1457413965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 7780
- Legal business name
- MOORESVILLE PHARMACY LLC
- Practice address
- 108 Leaning Oak Dr
Mooresville, NC 28117-6991 - Phone
- (704) 658-1184
- Fax
- (704) 658-1184
- NPI assigned
- Dec 14, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Douglas Alan Balog, BS PHARMACY
- Title
- Manager Owner
- Phone
- (704) 658-1184
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 7780 | NC | Primary |
Addresses
Primary practice location
108 Leaning Oak Dr
Mooresville, NC 28117-6991
Mailing address
108 Leaning Oak Dr
Mooresville, NC 28117-6991
Phone (704) 658-1184
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0497153 | Medicaid | NC | |
| 3438757 | Other | NCPDP | |
| 7703604 | Medicaid | NC | |
| 7780 | Other | NC | NORTH CAROLINA BOARD OF PHARMACY |
Other names 1
- HealthSmart Pharmacy
National Provider Directory
National Provider DirectoryLocations
108 Leaning Oak Dr
Mooresville, NC 28117
Phone (704) 658-1184
136 Stutts Rd
Ste 1
Mooresville, NC 28117
Phone (704) 799-0078
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1457413965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 LEANING OAK DR",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281176991",
"telephone_number": "704-658-1184",
"fax_number": "704-658-1184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 LEANING OAK DR",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281176991",
"telephone_number": "704-658-1184",
"fax_number": "704-658-1184"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOORESVILLE PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-14",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "BALOG",
"authorized_official_first_name": "DOUGLAS",
"authorized_official_middle_name": "ALAN",
"authorized_official_title_or_position": "MANAGER OWNER",
"authorized_official_telephone_number": "704-658-1184",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "BS PHARMACY"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NC",
"license": "7780",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0497153",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "3438757",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7703604",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH CAROLINA BOARD OF PHARMACY",
"identifier": "7780",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "HealthSmart Pharmacy",
"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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.