Healthcare Provider Details

I. General information

NPI: 1902686231
Provider Name (Legal Business Name): COURTNEY ENSOR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

1436 N BEND RD
JARRETTSVILLE MD
21084-1334
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7010
  • Fax:
Mailing address:
  • Phone: 443-807-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number25044
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: