Provider Demographics
NPI:1568049112
Name:BISHOP, CODY MICHAEL (CPHT)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:MICHAEL
Last Name:BISHOP
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WALKERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-6044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1942 PORT REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-3532
Practice Address - Country:US
Practice Address - Phone:540-282-6950
Practice Address - Fax:540-282-6947
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230032905183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician