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General NPI Number Information
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NPI Number | 1922869320
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Entity Type | Individual
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Provider Name | CODY SPRINGER
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Gender | Male
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 19216 FREEPORT ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330-1265
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Country | US
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Telephone | 763-241-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 25728 2ND ST W APT 302
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City | ZIMMERMAN
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State | MN
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Zip | 55398-7553
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Country | US
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Telephone | 701-840-9069
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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 | 126093
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License Number State | MN
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