Provider Demographics
NPI:1174855209
Name:MOONEY, COURTNEY JANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:JANNE
Last Name:MOONEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9379
Mailing Address - Country:US
Mailing Address - Phone:315-699-0340
Mailing Address - Fax:315-699-0348
Practice Address - Street 1:8150 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9379
Practice Address - Country:US
Practice Address - Phone:315-699-0340
Practice Address - Fax:315-699-0348
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist