Provider Demographics
NPI:1255452348
Name:MOODY, SUMMER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:WASHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, JD
Mailing Address - Street 1:428 S JAMES ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4318
Mailing Address - Country:US
Mailing Address - Phone:501-985-1535
Mailing Address - Fax:501-982-5294
Practice Address - Street 1:29 MEADOW RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6879
Practice Address - Country:US
Practice Address - Phone:501-851-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist