NPIMap

Organization Active NPI

Moultrie Pharmacy Inc

Doing business as Moultrie Pharmacy LTC

  • Long Term Care Pharmacy
  • St Augustine, FL
National Provider Identifier
1891656203
Registry record updated Nov 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
MOULTRIE PHARMACY INC
Doing business as
Moultrie Pharmacy LTC
Practice address
3690 US Highway 1 S
St Augustine, FL 32086-6498
Phone
(904) 794-1399
NPI assigned
Nov 24, 2025
Last updated
Nov 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MOULTRIE PHARMACY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 24, 2025

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

Authorized official

Name
Kevin Joseph DuaneNPI 1134527906
Title
Owner
Phone
(904) 765-3531

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X NU Primary

Addresses

Primary practice location

3690 US Highway 1 S
St Augustine, FL 32086-6498

Mailing address

7707 Merrill Rd Unit 8664
Jacksonville, FL 32239-7728

Other names 1

  • MOULTRIE PHARMACY LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Moultrie Pharmacy Inc2 organizations share this tax ID, including this one
Part of
Moultrie Pharmacy Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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": "1763942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763942400000",
    "number": "1891656203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7707 MERRILL RD UNIT 8664",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322397728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3690 US HIGHWAY 1 S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866498",
            "telephone_number": "904-794-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTRIE PHARMACY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOULTRIE PHARMACY INC",
        "enumeration_date": "2025-11-24",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A",
        "authorized_official_last_name": "DUANE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-765-3531"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOULTRIE PHARMACY LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2025; 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.