Healthcare Provider Details

I. General information

NPI: 1417873761
Provider Name (Legal Business Name): CODY COLLERT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4667
US

IV. Provider business mailing address

2890 TOWNSHIP ROAD 87
MOUNT CORY OH
45868-9654
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-3361
  • Fax:
Mailing address:
  • Phone: 567-525-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03446731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: