Basic Information
| Provider Information | |||||||||
| NPI: | 1053824672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOODY | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | SPENSER | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5727 MAGELLAN WAY APT 306 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276122265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525602466 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2201 N HERRITAGE ST | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285012223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525224902 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2017 | ||||||||
| LastUpdateDate: | 11/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 27362 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.