MEDICARE: CODY SPRINGER

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	126093	MN

General Provider Information

NPI Number	:	1922869320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY SPRINGER

Provider Business Mailing Address
First Line	:	25728 2ND ST W APT 302
Second Line	:
City	:	ZIMMERMAN
State	:	MN
Zip	:	55398-7553
Country	:	US
Telephone Number	:	701-840-9069
Fax Number	:

Provider Business Practice Location Address
First Line	:	19216 FREEPORT ST NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-1265
Country	:	US
Telephone Number	:	763-241-8112
Fax Number	:

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

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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Directions to “ CODY SPRINGER ” Practice Location

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