Organization
MOULTRIE PHARMACY INC
Active
Other names
MOULTRIE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DELAINE MCCARTY (OWNER)
(904) 794-1399
Entity
Organization
Contact information
Practice address
3690 US HIGHWAY 1 S, ST AUGUSTINE, FL 32086-6498
(904) 794-1399
(904) 794-1193
Mailing address
3690 US HIGHWAY 1 S, ST AUGUSTINE, FL 32086-6498
(904) 794-1399
(904) 794-1193
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH19146
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025956000
—
FL
05
—
025956001
—
FL
01
—
2015438
PK
—
05
—
686878996
—
FL
Enumeration date
10/27/2005
Last updated
03/29/2017
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