Healthcare Provider Details

I. General information

NPI: 1770103533
Provider Name (Legal Business Name): COURTNEY KOOGLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 S LOOP RD
EDGEWOOD KY
41017-5446
US

IV. Provider business mailing address

413 S LOOP RD
EDGEWOOD KY
41017-5446
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-3800
  • Fax: 859-301-3987
Mailing address:
  • Phone: 859-301-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number021483
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: