Provider Demographics
NPI:1548584931
Name:MOODY, LAURA JEAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:MOODY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 RT. 82 SUITE A BLDG. 5
Mailing Address - Street 2:TUMINARO PHARMACY
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533
Mailing Address - Country:US
Mailing Address - Phone:845-223-7858
Mailing Address - Fax:845-223-8271
Practice Address - Street 1:800 RT. 82 SUITE A BLDG. 5
Practice Address - Street 2:TUMINARO PHARMACY
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533
Practice Address - Country:US
Practice Address - Phone:845-223-7858
Practice Address - Fax:845-223-8271
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist