Provider Demographics
NPI:1568345916
Name:BOLAND, CODY (PHARMD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BOLAND
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 1:128 CRESCENT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-9119
Mailing Address - Country:US
Mailing Address - Phone:662-263-6482
Mailing Address - Fax:
Practice Address - Street 1:820 HIGHWAY 19 N STE 195
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5820
Practice Address - Country:US
Practice Address - Phone:719-448-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-102053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist