NPIMap

Organization Active NPI

Mooresville Pharmacy, LLC

  • Specialty Pharmacy
  • Mooresville, NC
National Provider Identifier
1861781718
Registry record updated Mar 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
License
7780 Issued in NC
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
Mar 31, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2011

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

Authorized official

Name
Mr. Douglas A Balog
Title
Owner/Manager
Phone
(704) 658-1184

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialty Pharmacy 3336S0011X 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 1

IdentifierTypeStateIssuer
0497153MedicaidNC

Other names 1

  • HealthSmart Pharmacy Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301529600000",
    "number": "1861781718",
    "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": "2011-03-31",
        "last_updated": "2011-03-31",
        "status": "A",
        "authorized_official_last_name": "BALOG",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "704-658-1184",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NC",
            "license": "7780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0497153",
            "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 31, 2011; 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.