Provider Demographics
NPI:1992518708
Name:KODE, VIJAYA
Entity type:Individual
Prefix:
First Name:VIJAYA
Middle Name:
Last Name:KODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 MIDDLEWICH DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6918
Mailing Address - Country:US
Mailing Address - Phone:954-562-2447
Mailing Address - Fax:
Practice Address - Street 1:3390 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1605
Practice Address - Country:US
Practice Address - Phone:314-824-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44330183500000X
MO2025000954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist