Provider Demographics
NPI:1134668395
Name:MOSS COMPOUNDING PHARMACY, LLC
Entity Type:Organization
Organization Name:MOSS COMPOUNDING PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-665-0289
Mailing Address - Street 1:2500 HOFFMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7407
Mailing Address - Country:US
Mailing Address - Phone:843-665-0289
Mailing Address - Fax:843-667-9964
Practice Address - Street 1:2500 HOFFMEYER RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7407
Practice Address - Country:US
Practice Address - Phone:843-665-0289
Practice Address - Fax:843-667-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC169523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy