Provider Demographics
NPI:1083793491
Name:BURRY, JAMES ALBERT JR (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALBERT
Last Name:BURRY
Suffix:JR
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 1:500 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5019
Mailing Address - Country:US
Mailing Address - Phone:352-787-3787
Mailing Address - Fax:352-787-6926
Practice Address - Street 1:500 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5019
Practice Address - Country:US
Practice Address - Phone:352-787-3787
Practice Address - Fax:352-787-6926
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013957Medicare UPIN