Provider Demographics
NPI:1245019546
Name:HERN, COURTNEY MAE (PHARMD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MAE
Last Name:HERN
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 1:2104 WESTERN HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2487
Mailing Address - Country:US
Mailing Address - Phone:505-485-6028
Mailing Address - Fax:
Practice Address - Street 1:2104 WESTERN HILLS DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2487
Practice Address - Country:US
Practice Address - Phone:505-485-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00010030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist