Provider Demographics
NPI:1548564404
Name:MOODY, BRINN RENEE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:BRINN
Middle Name:RENEE
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 1:754 MOORINGS DR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9405
Mailing Address - Country:US
Mailing Address - Phone:616-443-6833
Mailing Address - Fax:
Practice Address - Street 1:3876 E PARIS AVE SE
Practice Address - Street 2:SUITE 13
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-3974
Practice Address - Country:US
Practice Address - Phone:616-977-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020338961835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric