Provider Demographics
NPI:1871191718
Name:STEWART, CODY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:STEWART
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 1:906 DORTON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-9287
Mailing Address - Country:US
Mailing Address - Phone:606-499-1077
Mailing Address - Fax:
Practice Address - Street 1:906 DORTON BRANCH RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-9287
Practice Address - Country:US
Practice Address - Phone:606-499-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist