Provider Demographics
NPI:1285903542
Name:REDDELL, COURTNEY C (PHARM D)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:C
Last Name:REDDELL
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 1:6100 BROADMOOR ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3229
Mailing Address - Country:US
Mailing Address - Phone:913-262-7863
Mailing Address - Fax:913-262-7863
Practice Address - Street 1:6100 BROADMOOR ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3229
Practice Address - Country:US
Practice Address - Phone:913-262-7863
Practice Address - Fax:913-262-7863
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011004145183500000X
KS1-147681835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist