=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679594931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOODY DRUGS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 W TENNESSEE ST
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-764-6391
-----------------------------------------------------
Fax | 256-764-4279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 W TENNESSEE ST
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-764-6391
-----------------------------------------------------
Fax | 256-764-4279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ROBERT O'NEAL MOODY
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 256-764-6391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 106955
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------