Active NPI
Nicholas Allen Moody, PHARMD
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1285937052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302033536
- Practice address
- 3876 E Paris Ave SE
Suite 13
Grand Rapids, MI 49512-3974 - Phone
- (616) 977-9700
- Fax
- (616) 855-0937
- NPI assigned
- Dec 16, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302033536 | MI | Primary |
Addresses
Primary practice location
3876 E Paris Ave SE
Suite 13
Grand Rapids, MI 49512-3974
Mailing address
3876 E Paris Ave SE
Suite 13
Grand Rapids, MI 49512-3974
Phone (616) 977-9700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302033536 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292457600000",
"number": "1285937052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3876 E PARIS AVE SE",
"address_2": "SUITE 13",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495123974",
"telephone_number": "616-977-9700",
"fax_number": "616-855-0937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3876 E PARIS AVE SE",
"address_2": "SUITE 13",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495123974",
"telephone_number": "616-977-9700",
"fax_number": "616-855-0937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODY",
"first_name": "NICHOLAS",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-16",
"last_updated": "2010-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302033536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.