Provider Demographics
NPI:1093841181
Name:BURLESON, MICHAEL KYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KYLE
Last Name:BURLESON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 WILLOW OAK CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1716
Mailing Address - Country:US
Mailing Address - Phone:859-335-0091
Mailing Address - Fax:502-839-3976
Practice Address - Street 1:755 W BROADWAY ST STE 202
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1902
Practice Address - Country:US
Practice Address - Phone:502-839-3403
Practice Address - Fax:502-839-3976
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist