Provider Demographics
NPI:1083127948
Name:CARSON, COURTLAND M (CPHT)
Entity Type:Individual
Prefix:
First Name:COURTLAND
Middle Name:M
Last Name:CARSON
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4211
Mailing Address - Country:US
Mailing Address - Phone:972-575-8237
Mailing Address - Fax:
Practice Address - Street 1:6324 CUSTER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4211
Practice Address - Country:US
Practice Address - Phone:972-575-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246742183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician