Provider Demographics
NPI:1730763673
Name:BAIR, CODY TONGA (RPH)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:TONGA
Last Name:BAIR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4173 W 1630 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6176
Mailing Address - Country:US
Mailing Address - Phone:801-636-6047
Mailing Address - Fax:
Practice Address - Street 1:11525 S PARKWAY PLAZA DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5605
Practice Address - Country:US
Practice Address - Phone:801-316-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10350893-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist