Individual provider Active NPI

Jane Elizabeth Moody, RPH

  • Pharmacist
  • Pontiac, MI
National Provider Identifier
1629236807
Registry record updated May 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302027506 Issued in MI
Practice address
35 S Johnson St
Suite 1E
Pontiac, MI 48341-1658
Phone
(248) 334-9582
Fax
(248) 334-1908
NPI assigned
May 24, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302027506 MI Primary

Addresses

Primary practice location

35 S Johnson St
Suite 1E
Pontiac, MI 48341-1658

Mailing address

35 S Johnson St
Suite 1E
Pontiac, MI 48341-1658
Phone (248) 334-9582

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
5302027506MIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Schramm Professional Pharmacy, Inc Pharmacist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211587200000",
    "number": "1629236807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 S JOHNSON ST",
            "address_2": "SUITE 1E",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411658",
            "telephone_number": "248-334-9582",
            "fax_number": "248-334-1908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 S JOHNSON ST",
            "address_2": "SUITE 1E",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411658",
            "telephone_number": "248-334-9582",
            "fax_number": "248-334-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "JANE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-24",
        "last_updated": "2008-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302027506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.