Provider Demographics
NPI:1487250288
Name:AIKENS, COURTNEY DERRELL (RPH)
Entity type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:DERRELL
Last Name:AIKENS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 COTTON VIEW LN
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2728
Mailing Address - Country:US
Mailing Address - Phone:469-337-8828
Mailing Address - Fax:
Practice Address - Street 1:5659 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-6225
Practice Address - Country:US
Practice Address - Phone:214-252-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist