Provider Demographics
NPI:1073117263
Name:ROSS, COURTNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ROSS
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 1:404 ESTAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2540
Mailing Address - Country:US
Mailing Address - Phone:609-381-9669
Mailing Address - Fax:
Practice Address - Street 1:2920 ROUTE 73 N
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2058
Practice Address - Country:US
Practice Address - Phone:856-667-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03575100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist