Healthcare Provider Details

I. General information

NPI: 1932932654
Provider Name (Legal Business Name): OLIVIA HOPE MOODY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MAIN ST
OAKLAND ME
04963-4948
US

IV. Provider business mailing address

43 MAIN ST
OAKLAND ME
04963-4948
US

V. Phone/Fax

Practice location:
  • Phone: 207-465-4440
  • Fax:
Mailing address:
  • Phone: 207-465-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR72095
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: