Provider Demographics
NPI:1982028429
Name:SMITH, CODY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:SMITH
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 1:3623 SW 93RD ST
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:KS
Mailing Address - Zip Code:66546-9726
Mailing Address - Country:US
Mailing Address - Phone:620-664-8299
Mailing Address - Fax:
Practice Address - Street 1:4500 W 107TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-4025
Practice Address - Country:US
Practice Address - Phone:866-930-4146
Practice Address - Fax:866-930-4147
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist