=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982028429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CODY SMITH PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2014
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 W 107TH ST
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-930-4146
-----------------------------------------------------
Fax | 866-930-4147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3623 SW 93RD ST
-----------------------------------------------------
City | WAKARUSA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66546-9726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-664-8299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 15951
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------