Provider Demographics
NPI:1922712694
Name:RADER, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:RADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 STATE ROUTE 159
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8620
Mailing Address - Country:US
Mailing Address - Phone:740-779-8745
Mailing Address - Fax:
Practice Address - Street 1:445 SHAWNEE LN
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4145
Practice Address - Country:US
Practice Address - Phone:740-779-8745
Practice Address - Fax:740-779-4859
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist