Provider Demographics
NPI:1114226230
Name:CODY, DONALD ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ALAN
Last Name:CODY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MARSH OAK DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-4512
Mailing Address - Country:US
Mailing Address - Phone:912-265-4457
Mailing Address - Fax:
Practice Address - Street 1:3487 CYPRESS MILL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2857
Practice Address - Country:US
Practice Address - Phone:912-265-6330
Practice Address - Fax:912-265-0956
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist