Provider Demographics
NPI:1639420821
Name:ANDERSON, COURTNEY JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JEAN
Last Name:ANDERSON
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 1:1014 S MAY ST
Mailing Address - Street 2:UNIT #1W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4231
Mailing Address - Country:US
Mailing Address - Phone:330-360-2446
Mailing Address - Fax:
Practice Address - Street 1:15850 S 94TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4725
Practice Address - Country:US
Practice Address - Phone:708-349-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033285493183500000X
IL051295414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist