NPIMap

Organization Active NPI

Moose Pharmacy of Salisbury LLC

Doing business as Moose Pharmacy of Salisbury

  • Community/Retail Pharmacy
  • Salisbury, NC
National Provider Identifier
1669626164
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
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
Last updated
Nov 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

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

Authorized official

Name
Kyle Yoder, PHARMDNPI 1407024136
Title
President
Phone
(704) 636-6340

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 10174 NC Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1408 W Innes St
Salisbury, NC 28144-2502

Mailing address

1408 W Innes St
Salisbury, NC 28144-2502
Phone (704) 636-6340

Other names 1

  • Moose Pharmacy of Salisbury Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930024751 NC DME Supplier - Pharmacy 0244396265 Practice locations: Salisbury, NC
O20140610001589 NC Part B Supplier - Mass Immunization (Roster Biller Only) 0244396265 Practice locations: Salisbury, NC

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 1

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": "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moose Pharmacy of Salisbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salisbury, NC

Sources for this page

  • 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.