Provider Demographics
NPI:1538858394
Name:MOSS HOLLAND ENTERPRISES LLC
Entity type:Organization
Organization Name:MOSS HOLLAND ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-447-1959
Mailing Address - Street 1:PO BOX 21294
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-1294
Mailing Address - Country:US
Mailing Address - Phone:803-447-1959
Mailing Address - Fax:501-222-1807
Practice Address - Street 1:11621 RAINWOOD RD STE 7
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3947
Practice Address - Country:US
Practice Address - Phone:501-222-1002
Practice Address - Fax:501-222-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245929934OtherPIC NPI