Provider Demographics
NPI:1093097404
Name:BURNARD, AMY C
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:BURNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 NEW ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8825
Mailing Address - Country:US
Mailing Address - Phone:614-855-4806
Mailing Address - Fax:614-855-5143
Practice Address - Street 1:5555 NEW ALBANY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8825
Practice Address - Country:US
Practice Address - Phone:614-855-4806
Practice Address - Fax:614-855-5143
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03322002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist