Individual
CODY FREEZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
105 N GRAND ST STE 1, GREENFIELD, MO 65661-8198
(417) 637-2909
Mailing address
PO BOX 158, GREENFIELD, MO 65661-0158
(417) 637-2909
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2011021448
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011021448
MISSOURI BOARD OF PHARMACY LICENSE
MO
Enumeration date
05/03/2019
Last updated
05/03/2019
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