Organization
MD MOULTON LLC
Active
Other names
Mike's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MOULTON (OWNER/PHARMACIST)
(321) 783-7883
Entity
Organization
Contact information
Practice address
8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL 32920-4302
(321) 783-7883
(321) 783-7889
Mailing address
8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL 32920-4302
(321) 783-7883
(321) 783-7889
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26299
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006742800
—
FL
01
—
5711660
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/06/2012
Last updated
02/12/2013
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