Provider Demographics
NPI:1366875148
Name:HOUP, COURTNEY D
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:D
Last Name:HOUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BALSAM LN
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9580
Mailing Address - Country:US
Mailing Address - Phone:207-730-3711
Mailing Address - Fax:
Practice Address - Street 1:226 PARKER FARM RD
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-3150
Practice Address - Country:US
Practice Address - Phone:207-727-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist