MEDICARE: DR. COURTNEY MCDERMOTT PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH60162083	WA
2	183500000X	Pharmacist	21391	IA

General Provider Information

NPI Number	:	1063705549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY MCDERMOTT PHARMD

Provider Business Mailing Address
First Line	:	1101 3RD ST SE
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-5754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20518 108TH AVE SE
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-1542
Country	:	US
Telephone Number	:	253-854-2999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	05/17/2011

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