Provider Demographics
NPI:1437439981
Name:KOVAC, COURTNEY L (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:L
Last Name:KOVAC
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 S FOSSUM RD
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-8834
Mailing Address - Country:US
Mailing Address - Phone:847-682-4637
Mailing Address - Fax:
Practice Address - Street 1:5065 HONONEGAH RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-8682
Practice Address - Country:US
Practice Address - Phone:815-623-5079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist