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NPI Code Detail

MEDICARE: COURTNEY AMMONS

MEDICARE: COURTNEY AMMONS
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
1183500000XPharmacist051296172IL

General Provider Information

NPI Number : 1295182004
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY AMMONS
Provider Business Mailing Address
First Line : 7530 S STONY ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60649-3914
Country : US
Telephone Number : 773-288-7002
Fax Number : 773-288-7009
Provider Business Practice Location Address
First Line : 7530 S STONY ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60649-3914
Country : US
Telephone Number : 773-288-7002
Fax Number : 773-288-7009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2016
Last Update Date : 05/22/2016

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Directions to “ COURTNEY AMMONS ” Practice Location

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