Individual
CODY JACK GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACY TECH
Contact information
Practice address
857 E MAIN ST STE 3, WILLOW SPRINGS, MO 65793-1500
(417) 855-1085
(417) 855-1086
Mailing address
857 E MAIN ST STE 3, WILLOW SPRINGS, MO 65793-1500
(417) 855-1085
(417) 855-1086
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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