Healthcare Provider Details

I. General information

NPI: 1487484655
Provider Name (Legal Business Name): MOODRX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2024
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 COUNTRY CLUB DR
NEWARK OH
43055-2154
US

IV. Provider business mailing address

595 COUNTRY CLUB DR
NEWARK OH
43055-2154
US

V. Phone/Fax

Practice location:
  • Phone: 740-249-8080
  • Fax: 740-964-6060
Mailing address:
  • Phone: 740-334-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA M. JONES
Title or Position: NURSEPRACTITIONER
Credential: CNP
Phone: 740-334-2527