Provider Demographics
NPI:1932932654
Name:MOODY, OLIVIA HOPE (PHARMD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:HOPE
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 1:43 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-4948
Mailing Address - Country:US
Mailing Address - Phone:207-465-4440
Mailing Address - Fax:
Practice Address - Street 1:43 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-4948
Practice Address - Country:US
Practice Address - Phone:207-465-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR72095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist