Provider Demographics
NPI:1912976630
Name:MOODYCARE INC.
Entity type:Organization
Organization Name:MOODYCARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-745-5431
Mailing Address - Street 1:380 HOSPITAL DR.
Mailing Address - Street 2:STE 175-A
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217
Mailing Address - Country:US
Mailing Address - Phone:478-745-5431
Mailing Address - Fax:478-765-4359
Practice Address - Street 1:380 HOSPITAL DR.
Practice Address - Street 2:STE 175-A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-745-5431
Practice Address - Fax:478-765-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE004996333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1122376OtherNCPDP OR NABP NUMBER
1122376OtherNCPDP OR NABP NUMBER