Provider Demographics
NPI:1750783874
Name:PARKWAY PHARMACY OF MOODY, INC.
Entity type:Organization
Organization Name:PARKWAY PHARMACY OF MOODY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUCKER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:334-444-0376
Mailing Address - Street 1:1021 CROSSROADS PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-2615
Mailing Address - Country:US
Mailing Address - Phone:334-444-0376
Mailing Address - Fax:
Practice Address - Street 1:1021 CROSSROADS PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-2615
Practice Address - Country:US
Practice Address - Phone:334-444-0376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1144153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL114415OtherPHARMACY LICENSE NUMBER