Provider Demographics
NPI:1487191409
Name:TERMINE, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:TERMINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 GAUDET DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2224
Mailing Address - Country:US
Mailing Address - Phone:504-451-6180
Mailing Address - Fax:
Practice Address - Street 1:888 TERRY PKWY
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-5270
Practice Address - Country:US
Practice Address - Phone:504-392-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician