MOULTRIE PHARMACY INC NPI 1740270099

NPI Information

  • NPI: 1740270099
  • Provider Name: MOULTRIE PHARMACY INC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Doing Business As: MOULTRIE PHARMACY
  • Address: 3690 US HIGHWAY 1 S
    ST AUGUSTINE, FL
    ZIP 32086
  • Phone: (904) 794-1399

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NPI Details

MOULTRIE PHARMACY INC is a community/retail pharmacy pharmacy in St Augustine, FL. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. MOULTRIE PHARMACY INC NPI is 1740270099. The provider is registered as an organization entity type.
The provider Is Doing Business As Moultrie Pharmacy.

The provider's business location address is:

3690 US HIGHWAY 1 S
ST AUGUSTINE, FL
ZIP 32086-498
Phone: (904) 794-1399
Fax: (904) 794-1193

The provider's authorized official is Delaine Mccarty .
The authorized official title is Owner and has the following contact phone number (904) 794-1399.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
  • Fee covid-19 vac 13 res (HCPCS:0124A)
  • Influenza vaccine, quadrivalent, 0.5 ml dosage (HCPCS:90688)

The enumeration date for this NPI number is 10/27/2005 and was last updated on 3/29/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336C0004XPharmacyCompounding PharmacyNo
33336C0003XPharmacyCommunity/Retail PharmacyPH19146FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
14754970001MEDICARE NSC
22015438OTHERPK
3025956001MEDICAIDFLORIDA
4686878996MEDICAIDFLORIDA
5025956000MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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