Healthcare Provider Details

I. General information

NPI: 1699844811
Provider Name (Legal Business Name): COURTNEY VINCENT EATMON PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY LEIGH VINCENT PHARM. D

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

2293 CRAVAT PASS
LEXINGTON KY
40511-8365
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax: 859-281-4851
Mailing address:
  • Phone: 859-321-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number012972
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: