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General NPI Number Information
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NPI Number | 1205504206
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Entity Type | Individual
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Provider Name | CODY MONTGOMERY PRESCOD RPH
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Gender | Male
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 10/16/2021
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Provider Practice Location Address
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Address Line | 2300 DECKER BLVD
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City | COLUMBIA
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State | SC
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Zip | 29206-2311
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Country | US
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Telephone | 803-788-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 80 EDGEWOOD DR
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City | SAINT MATTHEWS
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State | SC
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Zip | 29135-8465
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Country | US
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Telephone | 732-306-4630
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 43168
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License Number State | SC
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