MEDICARE: COURTNEY MCKINNEY 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	6432736-1701	UT
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	S18170	AZ

General Provider Information

NPI Number	:	1114271038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MCKINNEY PHARMD

Provider Business Mailing Address
First Line	:	5121 S. COTTONWOOD ST.
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 S. COTTONWOOD ST.
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:	801-507-5404
Fax Number	:

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

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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