Provider Demographics
NPI:1205073301
Name:CARTER, COURTNEY MARIE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MARIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:MARIE
Other - Last Name:KRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:302 ENTERPRISE DR
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9601
Mailing Address - Country:US
Mailing Address - Phone:319-334-7131
Mailing Address - Fax:319-334-7133
Practice Address - Street 1:302 ENTERPRISE DR
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9601
Practice Address - Country:US
Practice Address - Phone:319-334-7131
Practice Address - Fax:319-334-7133
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-11
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118334183500000X
IA20965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20965OtherSTATE LICENSE
MN118334OtherSTATE LICENSE