Provider Demographics
NPI:1891210597
Name:BROWN, COURTNEY ALEXANDRA
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALEXANDRA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 WALKING STICK RD APT D
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-8060
Mailing Address - Country:US
Mailing Address - Phone:443-593-2774
Mailing Address - Fax:
Practice Address - Street 1:1000 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-8312
Practice Address - Country:US
Practice Address - Phone:410-828-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist