Provider Demographics
NPI:1467793166
Name:MOSHEIM DRUG, LLC
Entity Type:Organization
Organization Name:MOSHEIM DRUG, LLC
Other - Org Name:THE MEDICINE SHOPPE #1994
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:EPLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-422-2829
Mailing Address - Street 1:1238 EAST JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659
Mailing Address - Country:US
Mailing Address - Phone:423-422-2829
Mailing Address - Fax:
Practice Address - Street 1:6766 WEST ANDREW JOHNSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MOSHEIM
Practice Address - State:TN
Practice Address - Zip Code:37818
Practice Address - Country:US
Practice Address - Phone:423-422-2829
Practice Address - Fax:423-422-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1131332B00000X
TN5152333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies