Provider Demographics
NPI:1205504206
Name:PRESCOD, CODY MONTGOMERY (RPH)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:MONTGOMERY
Last Name:PRESCOD
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 1:80 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MATTHEWS
Mailing Address - State:SC
Mailing Address - Zip Code:29135-8465
Mailing Address - Country:US
Mailing Address - Phone:732-306-4630
Mailing Address - Fax:
Practice Address - Street 1:2300 DECKER BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-2311
Practice Address - Country:US
Practice Address - Phone:803-788-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist