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General NPI Number Information
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NPI Number | 1750783874
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Entity Type | Organization
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Legal Business Name | PARKWAY PHARMACY OF MOODY, INC.
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 1021 CROSSROADS PLAZA DRIVE
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City | MOODY
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State | AL
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Zip | 35004-2615
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Country | US
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Telephone | 334-444-0376
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 CROSSROADS PLAZA DRIVE
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City | MOODY
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State | AL
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Zip | 35004-2615
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Country | US
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Telephone | 334-444-0376
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | DR. TUCKER LEE MALONE
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Credential | PHARMD
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Telephone | 334-444-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 114415
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License Number State | AL
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