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General NPI Number Information
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NPI Number | 1265703334
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Entity Type | Individual
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Provider Name | LORENA MOODY PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2012
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Last Update Date | 01/22/2012
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Provider Practice Location Address
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Address Line | 4607 LINDBERGH DR
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City | JACKSON
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State | MS
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Zip | 39209-3855
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Country | US
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Telephone | 601-353-6142
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Fax |
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Provider Business Mailing Address
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Address Line | 343 HIGHLEADON CT
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City | MADISON
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State | MS
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Zip | 39110-7475
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E8796
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License Number State | MS
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