Provider Demographics
NPI:1962748459
Name:AUBERTINE, COURTNEY (PHARMD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:AUBERTINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 DORIS PARK DR
Mailing Address - Street 2:
Mailing Address - City:CONSTANTIA
Mailing Address - State:NY
Mailing Address - Zip Code:13044-2801
Mailing Address - Country:US
Mailing Address - Phone:315-559-4372
Mailing Address - Fax:
Practice Address - Street 1:315 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2431
Practice Address - Country:US
Practice Address - Phone:315-785-9079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI056885-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist