Provider Demographics
NPI:1215591912
Name:PICKENS, CODY SCOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:SCOTT
Last Name:PICKENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:WEWAHITCHKA
Mailing Address - State:FL
Mailing Address - Zip Code:32465-4305
Mailing Address - Country:US
Mailing Address - Phone:850-209-8407
Mailing Address - Fax:850-639-4077
Practice Address - Street 1:218 S HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:WEWAHITCHKA
Practice Address - State:FL
Practice Address - Zip Code:32465-4305
Practice Address - Country:US
Practice Address - Phone:850-639-2252
Practice Address - Fax:850-639-4077
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20804183500000X
FLPS58008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist