Provider Demographics
NPI:1568924629
Name:FRAUSTO, CODY PAUL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:PAUL
Last Name:FRAUSTO
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 1:9310 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6236
Mailing Address - Country:US
Mailing Address - Phone:806-338-0818
Mailing Address - Fax:
Practice Address - Street 1:3300 I 40 E
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79103-4801
Practice Address - Country:US
Practice Address - Phone:806-373-8722
Practice Address - Fax:806-373-6918
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist