MEDICARE: NIKIA MOODY PHARM. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP439504	PA

General Provider Information

NPI Number	:	1639797574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKIA MOODY PHARM. D

Provider Business Mailing Address
First Line	:	1117 S 23RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2834
Country	:	US
Telephone Number	:	267-235-8798
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-5802
Country	:	US
Telephone Number	:	215-463-0891
Fax Number	:	215-463-0895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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