Organization
MOOSE PHARMACY OF SALISBURY LLC
Active
Other names
Moose Pharmacy of Salisbury
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE YODER PHARMD (PRESIDENT)
(704) 636-6340
Entity
Organization
Contact information
Practice address
1408 W INNES ST, SALISBURY, NC 28144-2502
(704) 636-6340
(704) 647-0917
Mailing address
1408 W INNES ST, SALISBURY, NC 28144-2502
(704) 636-6340
(704) 636-6340
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10174
NC
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080-5530
—
NC
01
—
3412587
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
7701294
—
NC
Enumeration date
11/11/2008
Last updated
11/18/2010
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