Organization
MOSHEIM PHARMACY INC
Active
Organization
MOSHEIM PHARMACY INC
Active
Other names
MOSHEIM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES SUSONG PHRMD (PRESIDENT)
(423) 639-8631
Entity
Organization
Contact information
Practice address
6766 W JOHNSON HWY, MOSHEIM, TN 37818
(423) 422-9099
(423) 422-9760
Mailing address
PO BOX 100, MOSHEIM, TN 37818-0100
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2926
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4428163
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/26/2006
Last updated
02/15/2012
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