Healthcare Provider Details

I. General information

NPI: 1962748459
Provider Name (Legal Business Name): COURTNEY AUBERTINE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ARSENAL ST
WATERTOWN NY
13601-2431
US

IV. Provider business mailing address

165 DORIS PARK DR
CONSTANTIA NY
13044-2801
US

V. Phone/Fax

Practice location:
  • Phone: 315-785-9079
  • Fax:
Mailing address:
  • Phone: 315-559-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI056885-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: