Provider Demographics
NPI:1962844084
Name:HERRON, COURTNEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 OLD FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-2804
Mailing Address - Country:US
Mailing Address - Phone:540-482-0206
Mailing Address - Fax:
Practice Address - Street 1:290 OLD FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-2804
Practice Address - Country:US
Practice Address - Phone:540-482-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist