Provider Demographics
NPI:1184146623
Name:COURTNEY, KRISTIN BEVERLY (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:BEVERLY
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6857 STATE HIGHWAY 56 APT 1
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3584
Mailing Address - Country:US
Mailing Address - Phone:315-396-9148
Mailing Address - Fax:
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1445
Practice Address - Country:US
Practice Address - Phone:315-379-9620
Practice Address - Fax:866-309-3968
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist