Provider Demographics
NPI:1043317027
Name:MOOSE DRUG COMPANY
Entity type:Organization
Organization Name:MOOSE DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-784-9613
Mailing Address - Street 1:740 CHURCH ST N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4336
Mailing Address - Country:US
Mailing Address - Phone:704-784-9613
Mailing Address - Fax:704-784-9613
Practice Address - Street 1:740 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4336
Practice Address - Country:US
Practice Address - Phone:704-784-9613
Practice Address - Fax:704-789-9366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOOSE DRUG COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC050993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700860Medicaid
NC3426245OtherNABP NUMBER
NC7700860Medicaid