Provider Demographics
NPI:1588389118
Name:PEGRAM, COURTNEY LAURA (RPH)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LAURA
Last Name:PEGRAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-9324
Mailing Address - Country:US
Mailing Address - Phone:336-595-2638
Mailing Address - Fax:
Practice Address - Street 1:2912 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051-9324
Practice Address - Country:US
Practice Address - Phone:336-595-2638
Practice Address - Fax:336-595-7569
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213185183500000X
NC28390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist