Healthcare Provider Details

I. General information

NPI: 1760167597
Provider Name (Legal Business Name): CODY ALDEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CODY ALDEN BARLOW

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PLEASANT ST
FALL RIVER MA
02721-3017
US

IV. Provider business mailing address

1 STRATFORD RD APT 1
CRANSTON RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 774-301-9465
  • Fax:
Mailing address:
  • Phone: 774-301-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH241113
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: