Provider Demographics
NPI:1154643203
Name:GADONNIEX, COURTNEY EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:EDWARD
Last Name:GADONNIEX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13214 PLANTERS ROW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-0012
Mailing Address - Country:US
Mailing Address - Phone:704-301-0026
Mailing Address - Fax:803-631-4148
Practice Address - Street 1:5220 HIGHWAY 557
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-8517
Practice Address - Country:US
Practice Address - Phone:803-631-4144
Practice Address - Fax:803-631-4148
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4228741OtherNABP