Moulton's Pharmacy of Crestview, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MOULTON'S PHARMACY OF CRESTVIEW, INC.

Practice address

648 N Ferdon Blvd
Crestview, FL 32536-2165

Phone

(850) 682-6136

Fax

(850) 682-6185

NPI assigned

Apr 20, 2016

Last updated

Apr 20, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Doyle William Edmondson Jr., RPH

Title

President

Phone

(850) 682-6136

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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.

• Clinton Stephens, PHARMD.

  • Pharmacist
  • Crestview, FL
  • NPI 1538585195
  NPD (past)

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

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1871947499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "648 N FERDON BLVD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362165",
            "telephone_number": "850-682-6136",
            "fax_number": "850-682-6185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "648 N FERDON BLVD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362165",
            "telephone_number": "850-682-6136",
            "fax_number": "850-682-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTON'S PHARMACY OF CRESTVIEW, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-20",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "DOYLE",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-682-6136",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Katherine Morris
• Shelley Morris, LCSW
• Jennifer Renee Moser, MPT
• Timothy Alan Moses, MD
• Paul Nicholas Motta, M.D.
• Moulton's Pharmacy, Inc.
• Khalid Mohamed Moussa, MD
• Tiffany Moye
• Angela Murphy
• Kelly Murphy, RBT

• Community/Retail Pharmacy in Crestview, FL
• Providers in Crestview, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; 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.