Provider Demographics
NPI:1679957492
Name:MOODT, ROBYN ANN
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:ANN
Last Name:MOODT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8095 STATE ROUTE 534
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:OH
Mailing Address - Zip Code:44099-8710
Mailing Address - Country:US
Mailing Address - Phone:440-636-3524
Mailing Address - Fax:
Practice Address - Street 1:13207 RAVENNA RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7032
Practice Address - Country:US
Practice Address - Phone:440-285-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist