Provider Demographics
NPI:1386989796
Name:LURA, KODY JAY (PHARM D)
Entity type:Individual
Prefix:MR
First Name:KODY
Middle Name:JAY
Last Name:LURA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1518
Mailing Address - Country:US
Mailing Address - Phone:701-947-5313
Mailing Address - Fax:701-947-5377
Practice Address - Street 1:4 8TH ST N
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1518
Practice Address - Country:US
Practice Address - Phone:701-947-5313
Practice Address - Fax:701-947-5377
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist