Provider Demographics
NPI:1427301498
Name:JENNINGS, COURTNEY WILLIAMS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:WILLIAMS
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:162 TRAFTON RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27921-7605
Mailing Address - Country:US
Mailing Address - Phone:252-340-0279
Mailing Address - Fax:
Practice Address - Street 1:101 W EHRINGHAUS ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4921
Practice Address - Country:US
Practice Address - Phone:252-338-3933
Practice Address - Fax:252-338-1760
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist