1164514196 NPI number — ROBERT T. MOSS, JR DBA MOSS PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164514196 NPI number — ROBERT T. MOSS, JR DBA MOSS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT T. MOSS, JR DBA MOSS PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164514196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
804 2ND LOOP RD STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29505-2827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-665-0289
Provider Business Mailing Address Fax Number:
843-667-9964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 2ND LOOP RD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29505-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-665-0289
Provider Business Practice Location Address Fax Number:
843-667-9964
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
843-665-0289

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  50001280 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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