Provider Demographics
NPI:1053366161
Name:ULLRICH, COURTNEY EDISON (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:EDISON
Last Name:ULLRICH
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:EDISON
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCPS
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:PHARMACY (119)
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-903-4845
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:PHARMACY (119)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-903-4845
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL387411835P1200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist