Provider Demographics
NPI:1265781686
Name:POPP, COURTNEY ROSE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ROSE
Last Name:POPP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:ROSE
Other - Last Name:MCNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1109 E MOREHEAD ST APT 13
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2852
Mailing Address - Country:US
Mailing Address - Phone:248-255-8151
Mailing Address - Fax:
Practice Address - Street 1:8830 ALBEMARLE RD
Practice Address - Street 2:T1793
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-2616
Practice Address - Country:US
Practice Address - Phone:704-264-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038931183500000X
NC23972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist