Organization
MIDDLE MOODYCARE INC
Active
Other names
Powell's Bloomfield Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BENJAMIN MOODY III R.PH. (PHARMACIST)
(478) 781-1213
Entity
Organization
Contact information
Practice address
4839 BLOOMFIELD RD, MACON, GA 31206-4307
(478) 781-1213
(478) 788-9078
Mailing address
4839 BLOOMFIELD RD, MACON, GA 31206-4307
(478) 781-1213
(478) 788-9078
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHRE006040
GA
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006040
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000033448A
—
GA
01
—
000033448C
MEDICAID DME
GA
01
—
1111828
NCPDP
—
Enumeration date
09/19/2005
Last updated
05/20/2025
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