Healthcare Provider Details

I. General information

NPI: 1326988288
Provider Name (Legal Business Name): CODY RYAN THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GARLAND ST
EVERETT MA
02149-5066
US

IV. Provider business mailing address

203 CONCORD TPKE
CAMBRIDGE MA
02140-2062
US

V. Phone/Fax

Practice location:
  • Phone: 617-389-6270
  • Fax:
Mailing address:
  • Phone: 617-389-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1000802
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: