Provider Demographics
NPI:1982207072
Name:BOTTENFIELD, CODY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:BOTTENFIELD
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 1:1015 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4905
Mailing Address - Country:US
Mailing Address - Phone:540-885-7491
Mailing Address - Fax:844-411-6810
Practice Address - Street 1:1015 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4905
Practice Address - Country:US
Practice Address - Phone:540-885-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist