Provider Demographics
NPI:1508296781
Name:CODY, LEANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 3RD AVE S UNIT 2401
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2720
Mailing Address - Country:US
Mailing Address - Phone:612-867-4026
Mailing Address - Fax:
Practice Address - Street 1:3800 LEXINGTON AVE N
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2916
Practice Address - Country:US
Practice Address - Phone:651-486-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist