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General NPI Number Information
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NPI Number | 1215598883
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Entity Type | Individual
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Provider Name | BREANNA LEE LAWSON MOODY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 2250 LEESTOWN RD
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City | LEXINGTON
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State | KY
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Zip | 40511-1052
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Country | US
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Telephone | 859-233-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 840 HAYS BLVD APT 1207
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City | LEXINGTON
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State | KY
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Zip | 40509-8326
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Country | US
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Telephone | 859-559-3747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 019199
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License Number State | KY
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