# MOFFETTRX LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ole Towne Family Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114929296
- **Authorized official:** DR. RICHARD ANDREW MOFFETT PHARMD (PHARMACIST IN CHARGE/OWNER)
- **Authorized official phone:** (601) 693-0033

## Contact information

- **Practice address:** 2000 24TH AVE, MERIDIAN, MS 39301-3120
- **Practice address phone:** (601) 693-0033
- **Practice address fax:** (601) 693-0062
- **Mailing address:** 2000 24TH AVE, MERIDIAN, MS 39301-3120
- **Mailing address phone:** (601) 693-0033
- **Mailing address fax:** (601) 693-0062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 03424-01MM | MS | Yes |

## Other

- **Enumeration date:** 06/02/2005
- **Last updated:** 04/27/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330246 | — | MS |
| 01 | — | 2518629 | NABP | — |