Provider Demographics
NPI:1912663808
Name:GAITHER, CODY RYAN
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:RYAN
Last Name:GAITHER
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 1:806 HOKE ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1810
Mailing Address - Country:US
Mailing Address - Phone:256-492-4807
Mailing Address - Fax:
Practice Address - Street 1:806 HOKE ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1810
Practice Address - Country:US
Practice Address - Phone:256-492-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist