Provider Demographics
NPI:1508969569
Name:CARSTENSEN, CODY D (PHARMD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:D
Last Name:CARSTENSEN
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 1:512 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:SD
Mailing Address - Zip Code:57014
Mailing Address - Country:US
Mailing Address - Phone:605-563-2243
Mailing Address - Fax:
Practice Address - Street 1:512 BROADWAY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:SD
Practice Address - Zip Code:57014
Practice Address - Country:US
Practice Address - Phone:605-563-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist