Provider Demographics
NPI:1144025909
Name:HIDY, CODY MCKAY (PHARMD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:MCKAY
Last Name:HIDY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 RICHMOOR RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-5645
Mailing Address - Country:US
Mailing Address - Phone:937-215-7928
Mailing Address - Fax:
Practice Address - Street 1:3465 YORK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2675
Practice Address - Country:US
Practice Address - Phone:937-454-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist