Provider Demographics
NPI:1801497383
Name:CODY, CARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:CARIE
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CARIE
Other - Middle Name:
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1355 E DIVERNON RD
Mailing Address - Street 2:
Mailing Address - City:DIVERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62530-9042
Mailing Address - Country:US
Mailing Address - Phone:217-652-3146
Mailing Address - Fax:
Practice Address - Street 1:1100 LEJUNE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4537
Practice Address - Country:US
Practice Address - Phone:217-529-6299
Practice Address - Fax:217-529-6326
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist