Provider Demographics
NPI:1598249955
Name:BERKELEY, CODY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BERKELEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:MCMILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1226 MINERVAVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-8657
Mailing Address - Country:US
Mailing Address - Phone:803-917-7986
Mailing Address - Fax:
Practice Address - Street 1:4711 FOREST DR STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3125
Practice Address - Country:US
Practice Address - Phone:803-787-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty