Individual
CODY JACK GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACY TECH
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
19331
MO
183700000X
Pharmacy Technician
Primary
2024037403
MO
Other
Enumeration date
01/03/2025
Last updated
04/07/2026
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