Provider Demographics
NPI:1003368903
Name:ATZINGER, COURTNEY BLANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BLANE
Last Name:ATZINGER
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 1:1790 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-9098
Mailing Address - Country:US
Mailing Address - Phone:502-299-9208
Mailing Address - Fax:
Practice Address - Street 1:951 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2151
Practice Address - Country:US
Practice Address - Phone:859-885-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist