NPIMap

Organization Active NPI

Moon's Pharmacy LTC

Doing business as Moon's Pharmacy Inc

  • Long Term Care Pharmacy
  • Tifton, GA
National Provider Identifier
1922118769
Registry record updated Mar 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHRE008877 Issued in GA
Legal business name
MOON'S PHARMACY LTC
Doing business as
Moon's Pharmacy Inc
Practice address
711 2ND St W
Tifton, GA 31794-4201
Phone
(229) 256-0139
Fax
(229) 256-0140
NPI assigned
Aug 30, 2006
Last updated
Mar 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2014

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

Authorized official

Name
Catherine M. Maraman, PHARMDNPI 1548424401
Title
Owner
Phone
(229) 382-3711

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 PHRE008877 GA Primary

Addresses

Primary practice location

711 2ND St W
Tifton, GA 31794-4201

Mailing address

717 B W 2ND St
Tifton, GA 31794
Phone (229) 382-3711

Other identifiers 2

IdentifierTypeStateIssuer
00003855CMedicaidGA
1152482OtherNDCP

Other names 1

  • Moon's Pharmacy Inc Doing business as

National Provider Directory

National Provider Directory

Locations

711 2nd St W
Tifton, GA 31794
Phone (229) 256-0139

717 2nd St W
#B
Tifton, GA 31794

Practitioners & affiliated clinicians

Practitioners 2

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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1922118769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 B W 2ND ST",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-382-3711",
            "fax_number": "229-387-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 2ND ST W",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944201",
            "telephone_number": "229-256-0139",
            "fax_number": "229-256-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOON'S PHARMACY LTC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2014-03-26",
        "status": "A",
        "authorized_official_last_name": "MARAMAN",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-382-3711",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "GA",
            "license": "PHRE008877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00003855C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDCP",
            "identifier": "1152482",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moon's Pharmacy Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; 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.