Provider Demographics
NPI:1225753486
Name:CLECKLER, COURTNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CLECKLER
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 1:126 WESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3073
Mailing Address - Country:US
Mailing Address - Phone:912-660-3877
Mailing Address - Fax:
Practice Address - Street 1:125 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3672
Practice Address - Country:US
Practice Address - Phone:307-789-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist