Individual provider Active NPI

Courtney T Humphries, PHARMD

  • Pharmacist
  • Matthews, NC
National Provider Identifier
1376983478
Registry record updated Jul 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
23214 Issued in NC
Practice address
701 Crestdale Rd
Matthews, NC 28105-1700
Phone
(704) 844-4780
Fax
(704) 844-4208
NPI assigned
Jul 3, 2013
Last updated
Jul 4, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 35434 SC
Pharmacist 183500000X 23214 NC Primary

Addresses

Primary practice location

701 Crestdale Rd
Matthews, NC 28105-1700

Mailing address

813 Cedar St
MC Adenville, NC 28101-9001
Phone (704) 472-7999

Other names 1

  • Courtney F Tate Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
23214NCMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467590400000",
    "number": "1376983478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 CEDAR ST",
            "city": "MC ADENVILLE",
            "state": "NC",
            "postal_code": "281019001",
            "telephone_number": "704-472-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CRESTDALE RD",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281051700",
            "telephone_number": "704-844-4780",
            "fax_number": "704-844-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHRIES",
        "first_name": "COURTNEY",
        "middle_name": "T",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-03",
        "last_updated": "2016-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "35434",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "23214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "TATE",
            "middle_name": "F",
            "credential": "PHARMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Matthews, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.