Provider Demographics
NPI:1376983478
Name:HUMPHRIES, COURTNEY T (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:T
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:F
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:813 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MC ADENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28101-9001
Mailing Address - Country:US
Mailing Address - Phone:704-472-7999
Mailing Address - Fax:
Practice Address - Street 1:701 CRESTDALE RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1700
Practice Address - Country:US
Practice Address - Phone:704-844-4780
Practice Address - Fax:704-844-4208
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35434183500000X
NC23214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist