Provider Demographics
NPI:1265064422
Name:MOODY, BRANDON DEMON (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DEMON
Last Name:MOODY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4825 SWEETWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3098
Mailing Address - Country:US
Mailing Address - Phone:281-494-6555
Mailing Address - Fax:281-494-6568
Practice Address - Street 1:4825 SWEETWATER BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3098
Practice Address - Country:US
Practice Address - Phone:281-494-6555
Practice Address - Fax:281-494-6568
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX395461835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist