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NPI Code Detail

MEDICARE: COURTNEY CANNER PHARMD

MEDICARE: COURTNEY CANNER 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
1183500000XPharmacistS022151AZ

General Provider Information

NPI Number : 1487102992
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY CANNER PHARMD
Provider Business Mailing Address
First Line : 4302 W BUCKEYE RD STE 109
Second Line :
City : PHOENIX
State : AZ
Zip : 85043-4904
Country : US
Telephone Number : 855-250-7660
Fax Number :
Provider Business Practice Location Address
First Line : 4302 W BUCKEYE RD STE 109
Second Line :
City : PHOENIX
State : AZ
Zip : 85043-4904
Country : US
Telephone Number : 855-250-7660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2016
Last Update Date : 11/17/2022

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