Organization
MOODYCARE INC.
Active
Other names
Coliseum Park Professional Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BENJAMIN MOODY III RPH (PRESIDENT)
(478) 745-5431
Entity
Organization
Contact information
Practice address
380 HOSPITAL DR., STE 175-A, MACON, GA 31217
(478) 745-5431
(478) 765-4359
Mailing address
380 HOSPITAL DR., STE 175-A, MACON, GA 31217
(478) 745-5431
(478) 765-4359
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHRE004996
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1122376
NCPDP OR NABP NUMBER
—
Enumeration date
03/15/2006
Last updated
08/22/2020
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