Provider Demographics
NPI:1780921593
Name:CHASTAIN, COURTNEY JOBSON
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:JOBSON
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6396
Mailing Address - Country:US
Mailing Address - Phone:772-221-8392
Mailing Address - Fax:772-221-8529
Practice Address - Street 1:6550 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6396
Practice Address - Country:US
Practice Address - Phone:772-221-8392
Practice Address - Fax:772-221-8529
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist