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General NPI Number Information
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NPI Number | 1164213500
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Entity Type | Individual
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Provider Name | GARY COZAD
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Gender |
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 9800 SE WASHINGTON ST CVS PHARMACY
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City | PORTLAND
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State | OR
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Zip | 97216-2420
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Country | US
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Telephone | 503-252-5934
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 GENERAL ANDERSON RD APT L110
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City | VANCOUVER
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State | WA
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Zip | 98661-9006
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Country | US
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Telephone | 941-735-2583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | CPT-0015317
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License Number State | OR
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