Provider Demographics
NPI:1669893194
Name:STRODTMAN-PETTIT, CORTNEY RAE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:RAE
Last Name:STRODTMAN-PETTIT
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 1:300 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1106
Mailing Address - Country:US
Mailing Address - Phone:660-537-3391
Mailing Address - Fax:
Practice Address - Street 1:300 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1106
Practice Address - Country:US
Practice Address - Phone:660-248-2275
Practice Address - Fax:660-248-2858
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist