Provider Demographics
NPI:1164213500
Name:COZAD, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:COZAD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 GENERAL ANDERSON RD APT L110
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-9006
Mailing Address - Country:US
Mailing Address - Phone:941-735-2583
Mailing Address - Fax:
Practice Address - Street 1:9800 SE WASHINGTON ST
Practice Address - Street 2:CVS PHARMACY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2420
Practice Address - Country:US
Practice Address - Phone:503-252-5934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0015317183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician