Provider Demographics
NPI:1609328509
Name:AMBROISE, COURTNEY ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:AMBROISE
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 1:1013 BIG APPLE LANE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582
Mailing Address - Country:US
Mailing Address - Phone:225-931-7482
Mailing Address - Fax:
Practice Address - Street 1:185 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-3925
Practice Address - Country:US
Practice Address - Phone:337-364-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist