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NPI Code Detail

MEDICARE: DR. CODY DARRYL IRICK PHARMD

MEDICARE: DR. CODY DARRYL IRICK PHARMD
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
1183500000XPharmacist41185TN

General Provider Information

NPI Number : 1972018240
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CODY DARRYL IRICK PHARMD
Provider Business Mailing Address
First Line : 1619 W MARKET ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6018
Country : US
Telephone Number : 423-926-9137
Fax Number :
Provider Business Practice Location Address
First Line : 1619 W MARKET ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6018
Country : US
Telephone Number : 423-926-9137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2017
Last Update Date : 12/08/2017

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