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Contact Information

MOOSE PHARMACY OF MT HOLLY LLC
125 W CENTRAL AVE
MOUNT HOLLY, NC28120
 Phone: 704-827-2211
 Fax: 704-827-7134
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Compounding Pharmacy

3336C0004X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for MOOSE PHARMACY OF MT HOLLY LLC

NPI Number 1437648334
LBN Legal business name MOOSE PHARMACY OF MT HOLLY LLC
Authorized official KYLE YODER - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/07/2018
Last updated 05/18/2018 - About 8 years ago
Identifiers
NC License # 13746
NC Medicaid PENDING
Other 2177554 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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