Provider Demographics
NPI:1033562517
Name:BURNS, MICHAEL (PHARMD, MPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-3120
Mailing Address - Country:US
Mailing Address - Phone:716-957-0087
Mailing Address - Fax:
Practice Address - Street 1:81 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-9638
Practice Address - Country:US
Practice Address - Phone:716-735-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist