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NPI Code Detail

MEDICARE: JODY N MOORE

MEDICARE:   JODY N MOORE
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
1183500000XPharmacist5302030691MI

General Provider Information

NPI Number : 1831348630
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODY N MOORE
Provider Business Mailing Address
First Line : 219 N MAIN ST
Second Line :
City : NASHVILLE
State : MI
Zip : 49073-9577
Country : US
Telephone Number : 517-852-0845
Fax Number :
Provider Business Practice Location Address
First Line : 219 N MAIN ST
Second Line :
City : NASHVILLE
State : MI
Zip : 49073-9577
Country : US
Telephone Number : 517-852-0845
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2008
Last Update Date : 09/17/2008

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Directions to “ JODY N MOORE ” Practice Location

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