Provider Demographics
NPI:1568000206
Name:WILLOUGHBY, COURTNEY TAYLOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:WILLOUGHBY
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 1:369 SHADY PINES ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1548
Mailing Address - Country:US
Mailing Address - Phone:901-833-1491
Mailing Address - Fax:
Practice Address - Street 1:6660 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3625
Practice Address - Country:US
Practice Address - Phone:901-757-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN411681835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist