Provider Demographics
NPI:1043345135
Name:MOORESVILLE PHARMACY EAST LLC
Entity type:Organization
Organization Name:MOORESVILLE PHARMACY EAST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOUCHINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-799-6870
Mailing Address - Street 1:439 E STATESVILLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2533
Mailing Address - Country:US
Mailing Address - Phone:877-454-0448
Mailing Address - Fax:
Practice Address - Street 1:439 E STATESVILLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2533
Practice Address - Country:US
Practice Address - Phone:877-454-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3440093OtherNABP