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NPI Code Detail

MEDICARE: CODY MICHAEL CHILDERS PHARM. D.

MEDICARE: CODY MICHAEL CHILDERS 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
1183500000XPharmacistE-14467MS
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistE-14467MS

General Provider Information

NPI Number : 1306298633
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODY MICHAEL CHILDERS PHARM. D.
Provider Business Mailing Address
First Line : 145 MULLHERRIN DR
Second Line :
City : MADISON
State : MS
Zip : 39110-4534
Country : US
Telephone Number : 901-482-1689
Fax Number :
Provider Business Practice Location Address
First Line : 6745 S SIWELL RD
Second Line :
City : BYRAM
State : MS
Zip : 39272-8747
Country : US
Telephone Number : 601-863-2004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2016
Last Update Date : 01/13/2020

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