Provider Demographics
NPI:1558668954
Name:MOODY, NANCI WHALEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:NANCI
Middle Name:WHALEY
Last Name:MOODY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NANCI
Other - Middle Name:PAULENE
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1205 RACHEL ST
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-0581
Mailing Address - Country:US
Mailing Address - Phone:865-428-1076
Mailing Address - Fax:
Practice Address - Street 1:2453 BOYDS CREEK HWY STE 102
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37876-0676
Practice Address - Country:US
Practice Address - Phone:865-428-7439
Practice Address - Fax:865-453-4515
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26681183500000X
AL15691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist