Moose Pharmacy of Salisbury LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

10174 Issued in NC

Legal business name

MOOSE PHARMACY OF SALISBURY LLC

Doing business as

Moose Pharmacy of Salisbury

Practice address

1408 W Innes St
Salisbury, NC 28144-2502

Phone

(704) 636-6340

Fax

(704) 647-0917

NPI assigned

Nov 11, 2008

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

President

Phone

(704) 636-6340

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Moose Pharmacy of Salisbury Doing business as

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

Tax ID family

Moose Pharmacy of Salisbury2 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 Salisbury

  • Long Term Care Pharmacy
  • Salisbury, NC
  • NPI 1033576087
  NPD tax ID

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1669626164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 W INNES ST",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281442502",
            "telephone_number": "704-636-6340",
            "fax_number": "704-636-6340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 W INNES ST",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281442502",
            "telephone_number": "704-636-6340",
            "fax_number": "704-647-0917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE PHARMACY OF SALISBURY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-11",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "YODER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-636-6340",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "10174",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7701294",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3412587",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080-5530",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moose Pharmacy of Salisbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert Gene Moore, MD
• Sylvia Pope Moore, M.A., CCC-SLP
• Taylor Moore
• Valerie Lynn Moore, MD
• Moose Pharmacy of Salisbury
• Tasha S Moose, PHARM.D.
• Candace Pait Morales, LAT, ATC
• Brooke Moran, MS, LAT, ATC
• Diana Moreno, MSPT
• Theodore Lynn Moretz, PH.D.

• Community/Retail Pharmacy in Salisbury, NC
• Providers in Salisbury, 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 Nov 18, 2010; 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.