Provider Demographics
NPI:1922639780
Name:HYMAS, CODY (RPH)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:HYMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 W 5600 S STE 110
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9106
Mailing Address - Country:US
Mailing Address - Phone:801-825-6400
Mailing Address - Fax:801-825-6449
Practice Address - Street 1:3443 W 5600 S STE 110
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9106
Practice Address - Country:US
Practice Address - Phone:801-825-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3358022-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist