Provider Demographics
NPI:1477570364
Name:MOYES PHARMACY INC
Entity Type:Organization
Organization Name:MOYES PHARMACY INC
Other - Org Name:MOYES PHARMACY LOCUST GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-957-6004
Mailing Address - Street 1:3798 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3632
Mailing Address - Country:US
Mailing Address - Phone:770-957-6004
Mailing Address - Fax:770-914-0961
Practice Address - Street 1:3798 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3632
Practice Address - Country:US
Practice Address - Phone:770-957-6004
Practice Address - Fax:770-914-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1140259OtherNCPDP
GA000596637AMedicaid
GA000596637AMedicaid