Provider Demographics
NPI:1982129375
Name:CARTER, CRICKET COURTNEY (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CRICKET
Middle Name:COURTNEY
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:ANN
Other - Last Name:BROOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7170 SAND TRAP DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-9549
Mailing Address - Country:US
Mailing Address - Phone:207-313-9628
Mailing Address - Fax:
Practice Address - Street 1:4385 VENETUCCI BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4049
Practice Address - Country:US
Practice Address - Phone:719-637-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPI45615183500000X
COPHA.0023446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist