Provider Demographics
NPI:1699252221
Name:SMITH, COURTNEY TAYLOR (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:TAYLOR
Other - Last Name:GICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4595 N 635 W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-8982
Mailing Address - Country:US
Mailing Address - Phone:260-388-3687
Mailing Address - Fax:
Practice Address - Street 1:4595 N 635 W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-8982
Practice Address - Country:US
Practice Address - Phone:260-388-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027777A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist