Provider Demographics
NPI:1215627120
Name:MOOSE DRUG COMPANY
Entity type:Organization
Organization Name:MOOSE DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WHITAKER
Authorized Official - Last Name:MOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-436-9613
Mailing Address - Street 1:1750 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:LOCUST
Mailing Address - State:NC
Mailing Address - Zip Code:28097-9793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 MAIN ST W
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-9793
Practice Address - Country:US
Practice Address - Phone:704-888-2114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOOSE DRUG COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy