Provider Demographics
NPI:1073262069
Name:BURDETTE, BRIANNA MICHELE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MICHELE
Last Name:BURDETTE
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 1:1505 HURRICANE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-7369
Mailing Address - Country:US
Mailing Address - Phone:606-392-1450
Mailing Address - Fax:
Practice Address - Street 1:402 RICHMOND RD N STE A
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1133
Practice Address - Country:US
Practice Address - Phone:859-986-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist