Provider Demographics
NPI:1275294340
Name:JUSTUS, CODY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:
Last Name:JUSTUS
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 1:24782 MOCK KNOB RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-5610
Mailing Address - Country:US
Mailing Address - Phone:276-220-1117
Mailing Address - Fax:
Practice Address - Street 1:901 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-2303
Practice Address - Country:US
Practice Address - Phone:540-980-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist