MEDICARE: CODY SCOTT PICKENS PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20804	AL
2	183500000X	Pharmacist	PS58008	FL

General Provider Information

NPI Number	:	1215591912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY SCOTT PICKENS PHARM.D.

Provider Business Mailing Address
First Line	:	218 S HIGHWAY 71
Second Line	:
City	:	WEWAHITCHKA
State	:	FL
Zip	:	32465-4305
Country	:	US
Telephone Number	:	850-209-8407
Fax Number	:	850-639-4077

Provider Business Practice Location Address
First Line	:	218 S HIGHWAY 71
Second Line	:
City	:	WEWAHITCHKA
State	:	FL
Zip	:	32465-4305
Country	:	US
Telephone Number	:	850-639-2252
Fax Number	:	850-639-4077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2019
Last Update Date	:	04/28/2019

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