Provider Demographics
NPI:1659757540
Name:CAUDILL, COURTNEY KIVETT (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KIVETT
Last Name:CAUDILL
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 1:7341 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-8513
Mailing Address - Country:US
Mailing Address - Phone:336-963-1026
Mailing Address - Fax:
Practice Address - Street 1:550 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4710
Practice Address - Country:US
Practice Address - Phone:336-625-1360
Practice Address - Fax:336-625-1889
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7003921835P0018X
NC25319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist