Provider Demographics
NPI:1225550437
Name:JARVIS, COURTNEY IZZO (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:IZZO
Last Name:JARVIS
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 1:2028 BRICK KILN PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8759
Mailing Address - Country:US
Mailing Address - Phone:774-239-4883
Mailing Address - Fax:
Practice Address - Street 1:1952 LONG GROVE DR STE 5
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7579
Practice Address - Country:US
Practice Address - Phone:843-654-4013
Practice Address - Fax:843-654-4014
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist