Healthcare Provider Details

I. General information

NPI: 1821901455
Provider Name (Legal Business Name): COURTNEY KOLINA LYTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3396 N STOCKTON HILL RD
KINGMAN AZ
86409-3648
US

IV. Provider business mailing address

3396 N STOCKTON HILL RD
KINGMAN AZ
86409-3648
US

V. Phone/Fax

Practice location:
  • Phone: 928-692-0555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25337
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS028105
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: