Provider Demographics
NPI:1962843474
Name:MOSPAN, CORTNEY MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CORTNEY
Middle Name:MARIE
Last Name:MOSPAN
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 1:7903 PROVIDENCE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9763
Mailing Address - Country:US
Mailing Address - Phone:704-316-4460
Mailing Address - Fax:704-316-4466
Practice Address - Street 1:7903 PROVIDENCE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9763
Practice Address - Country:US
Practice Address - Phone:704-316-4460
Practice Address - Fax:704-316-4466
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3232704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist