Provider Demographics
NPI:1104467422
Name:WILCOTT, COURTNEY BROOKE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:BROOKE
Last Name:WILCOTT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 AMADOR LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3611
Mailing Address - Country:US
Mailing Address - Phone:702-325-8325
Mailing Address - Fax:
Practice Address - Street 1:3411 SAINT ROSE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4570
Practice Address - Country:US
Practice Address - Phone:702-803-7054
Practice Address - Fax:702-803-7045
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist