Provider Demographics
NPI:1366464604
Name:MOODY, ROBERT BENJAMIN III (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:MOODY
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 MILLRUN CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-7538
Mailing Address - Country:US
Mailing Address - Phone:478-471-8686
Mailing Address - Fax:
Practice Address - Street 1:380 HOSPITAL DR STE 175-A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8001
Practice Address - Country:US
Practice Address - Phone:478-745-5431
Practice Address - Fax:478-765-4359
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist