Provider Demographics
NPI:1063556678
Name:CHURCH, CODY J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:J
Last Name:CHURCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 N 3RD AVE
Mailing Address - Street 2:PO BOX 81
Mailing Address - City:CANISTOTA
Mailing Address - State:SD
Mailing Address - Zip Code:57012
Mailing Address - Country:US
Mailing Address - Phone:605-321-2877
Mailing Address - Fax:
Practice Address - Street 1:4901 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0444
Practice Address - Country:US
Practice Address - Phone:605-321-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist