Healthcare Provider Details

I. General information

NPI: 1053824672
Provider Name (Legal Business Name): ERIC SPENSER MOODY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N HERRITAGE ST
KINSTON NC
28501-2223
US

IV. Provider business mailing address

5727 MAGELLAN WAY APT 306
RALEIGH NC
27612-2265
US

V. Phone/Fax

Practice location:
  • Phone: 252-522-4902
  • Fax:
Mailing address:
  • Phone: 252-560-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27362
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: