Active NPI
Cody Lee Hattenberger, PHARM.D
- Pharmacist
- McConnell Afb, KS
National Provider Identifier
1083103154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S023388
- Practice address
- 57950 Leavenworth St
McConnell Afb, KS 67221-3506 - Phone
- (163) 759-5277
- NPI assigned
- May 4, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S023388 | AZ | Primary |
Addresses
Primary practice location
57950 Leavenworth St
McConnell Afb, KS 67221-3506
Mailing address
15835 W Supai Dr
Goodyear, AZ 85338-3301
Phone (218) 213-2521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S023388 | AZ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628208000000",
"number": "1083103154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15835 W SUPAI DR",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853383301",
"telephone_number": "218-213-2521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57950 LEAVENWORTH ST",
"city": "MCCONNELL AFB",
"state": "KS",
"postal_code": "672213506",
"telephone_number": "163-759-5277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATTENBERGER",
"first_name": "CODY",
"middle_name": "LEE",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-04",
"last_updated": "2021-08-06",
"certification_date": "2021-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S023388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McConnell Afb, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.