Organization
MOOSE PHARMACY OF MT HOLLY LLC
Active
Other names
Moose Pharmacy of Mt. Holly
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE YODER PHARMD (MANAGER)
(704) 827-2211
Entity
Organization
Contact information
Practice address
125 W CENTRAL AVE, MOUNT HOLLY, NC 28120
(704) 827-2211
(704) 827-7134
Mailing address
125 W CENTRAL AVE, MOUNT HOLLY, NC 28120-1616
(704) 827-2211
(704) 827-7134
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
13746
NC
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177554
PK
—
05
—
PENDING
—
NC
Enumeration date
05/07/2018
Last updated
05/18/2018
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