Provider Demographics
NPI:1104801810
Name:MOODY, EMILY NICHOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:NICHOLE
Last Name:MOODY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 MOODYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-4339
Mailing Address - Country:US
Mailing Address - Phone:931-864-3043
Mailing Address - Fax:
Practice Address - Street 1:346 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3407
Practice Address - Country:US
Practice Address - Phone:931-879-8133
Practice Address - Fax:931-879-9365
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist