Provider Demographics
NPI:1942029954
Name:ENNIS, COURTNEY AYANA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:AYANA
Last Name:ENNIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:AYANA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 HUISACHE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4205
Mailing Address - Country:US
Mailing Address - Phone:972-639-7444
Mailing Address - Fax:
Practice Address - Street 1:306 HUISACHE ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4205
Practice Address - Country:US
Practice Address - Phone:972-639-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist