Provider Demographics
NPI:1265268981
Name:THOMPSON, CODY ZACHARY
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:ZACHARY
Last Name:THOMPSON
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 1:6030 WENTWORTH LN SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-3285
Mailing Address - Country:US
Mailing Address - Phone:330-413-3549
Mailing Address - Fax:
Practice Address - Street 1:11031 STATE ROUTE 212 NE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612-8744
Practice Address - Country:US
Practice Address - Phone:330-874-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist