Provider Demographics
NPI:1316792583
Name:SCOTT, CODY R (PHARMD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:R
Last Name:SCOTT
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 1:4940 O ST # 1053
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1957
Mailing Address - Country:US
Mailing Address - Phone:308-408-0464
Mailing Address - Fax:
Practice Address - Street 1:1603 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1164
Practice Address - Country:US
Practice Address - Phone:308-408-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE171411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist