Provider Demographics
NPI:1619302718
Name:LOVELACE, CORTLYN BRENAE' (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CORTLYN
Middle Name:BRENAE'
Last Name:LOVELACE
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 1:8789 FM 1960 BYPASS RD W
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4021
Mailing Address - Country:US
Mailing Address - Phone:281-548-1020
Mailing Address - Fax:
Practice Address - Street 1:8789 FM 1960 BYPASS RD W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4021
Practice Address - Country:US
Practice Address - Phone:281-548-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-08
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19959183500000X
TX53185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist