Provider Demographics
NPI:1396981239
Name:MOOSE DRUG COMPANY
Entity type:Organization
Organization Name:MOOSE DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-436-9613
Mailing Address - Street 1:8374 WEST FRANKLIN STREET
Mailing Address - Street 2:PO BOX 67
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-0067
Mailing Address - Country:US
Mailing Address - Phone:704-436-9613
Mailing Address - Fax:704-436-6512
Practice Address - Street 1:8374 WEST FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124-0067
Practice Address - Country:US
Practice Address - Phone:704-436-9613
Practice Address - Fax:704-436-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC053953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy