Provider Demographics
NPI:1912775149
Name:BRENT, CORTNEY MARIE
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:MARIE
Last Name:BRENT
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 1:317 CROMWELL CT
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2697
Mailing Address - Country:US
Mailing Address - Phone:630-478-5970
Mailing Address - Fax:
Practice Address - Street 1:5000 STADIUM DR
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2301
Practice Address - Country:US
Practice Address - Phone:779-513-8397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL305924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist