Provider Demographics
NPI:1740892900
Name:WILL, CODY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:WILL
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 1:195 HIDDEN GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-1527
Mailing Address - Country:US
Mailing Address - Phone:409-658-8848
Mailing Address - Fax:
Practice Address - Street 1:333 HIGHWAY 96 S
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-4807
Practice Address - Country:US
Practice Address - Phone:409-385-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist