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General NPI Number Information
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NPI Number | 1154694487
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Entity Type | Organization
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Legal Business Name | SOUTHERN MOODYCARE INC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 84 MAXWELL ST SE
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City | ARLINGTON
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State | GA
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Zip | 39813-8712
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Country | US
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Telephone | 229-725-4212
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Fax | 229-725-5242
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Provider Business Mailing Address
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Address Line | 84 MAXWELL ST SE
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City | ARLINGTON
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State | GA
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Zip | 39813-8712
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Country | US
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Telephone | 229-725-4212
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Fax | 229-725-5242
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | MR. CARSON RAY
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Credential |
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Telephone | 229-725-4212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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