Healthcare Provider Details

I. General information

NPI: 1215598883
Provider Name (Legal Business Name): BREANNA LEE LAWSON MOODY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

IV. Provider business mailing address

840 HAYS BLVD APT 1207
LEXINGTON KY
40509-8326
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 859-559-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number019199
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: