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General NPI Number Information
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NPI Number | 1801881545
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Entity Type | Organization
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Legal Business Name | MIDDLE MOODYCARE INC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 4839 BLOOMFIELD RD
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City | MACON
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State | GA
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Zip | 31206-4307
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Country | US
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Telephone | 478-781-1213
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Fax | 478-788-9078
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Provider Business Mailing Address
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Address Line | 4839 BLOOMFIELD RD
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City | MACON
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State | GA
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Zip | 31206-4307
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Country | US
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Telephone | 478-781-1213
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Fax | 478-788-9078
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. ROBERT BENJAMIN MOODY III
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Credential | R.PH.
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Telephone | 478-781-1213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHRE006040
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE006040
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License Number State | GA
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