Provider Demographics
NPI:1013534882
Name:BURLESON, KRISTAL LEIGH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:LEIGH
Last Name:BURLESON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E MERRITT ISLAND CSWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3632
Mailing Address - Country:US
Mailing Address - Phone:321-453-2540
Mailing Address - Fax:321-452-3359
Practice Address - Street 1:11 E MERRITT ISLAND CSWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3632
Practice Address - Country:US
Practice Address - Phone:321-453-2540
Practice Address - Fax:321-452-3359
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist