Healthcare Provider Details

I. General information

NPI: 1316792583
Provider Name (Legal Business Name): CODY R SCOTT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

4940 O ST # 1053
LINCOLN NE
68510-1957
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-5533
  • Fax:
Mailing address:
  • Phone: 308-408-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number17141
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: