Provider Demographics
NPI:1376287748
Name:WILSON, COURTNEY ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ANNE
Last Name:WILSON
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 1:377 VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-8062
Mailing Address - Country:US
Mailing Address - Phone:860-944-4420
Mailing Address - Fax:
Practice Address - Street 1:377 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-8062
Practice Address - Country:US
Practice Address - Phone:860-944-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist