Provider Demographics
NPI:1386780534
Name:MOOSE, WILLIAM WHITAKER JR (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WHITAKER
Last Name:MOOSE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8374 W. FRANKLIN ST.
Mailing Address - Street 2:PO BOX 67
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124
Mailing Address - Country:US
Mailing Address - Phone:704-436-9613
Mailing Address - Fax:704-436-6512
Practice Address - Street 1:8374 W. FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124
Practice Address - Country:US
Practice Address - Phone:704-436-9613
Practice Address - Fax:704-436-6512
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist