MEDICARE: MRS. CRICKET COURTNEY CARTER 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	PI45615	ME
2	183500000X	Pharmacist	PHA.0023446	CO

General Provider Information

NPI Number	:	1982129375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRICKET COURTNEY CARTER PHARMD

Provider Business Mailing Address
First Line	:	7170 SAND TRAP DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-9549
Country	:	US
Telephone Number	:	207-313-9628
Fax Number	:

Provider Business Practice Location Address
First Line	:	4385 VENETUCCI BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4049
Country	:	US
Telephone Number	:	719-637-3874
Fax Number	:

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	03/09/2023

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