Provider Demographics
NPI:1164514196
Name:ROBERT T. MOSS, JR DBA MOSS PHARMACY
Entity Type:Organization
Organization Name:ROBERT T. MOSS, JR DBA MOSS PHARMACY
Other - Org Name:MOSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:843-665-0289
Mailing Address - Street 1:804 2ND LOOP RD STE E
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-2827
Mailing Address - Country:US
Mailing Address - Phone:843-665-0289
Mailing Address - Fax:843-667-9964
Practice Address - Street 1:804 2ND LOOP RD STE E
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2827
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:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500012803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AM7856125OtherDEA NUMBER
AM7856125OtherDEA NUMBER