Provider Demographics
NPI:1114517232
Name:BURNS, JOE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BURNS
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 1:1152 E LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:TARRANT
Mailing Address - State:AL
Mailing Address - Zip Code:35217-2402
Mailing Address - Country:US
Mailing Address - Phone:205-841-6421
Mailing Address - Fax:
Practice Address - Street 1:1152 E LAKE BLVD
Practice Address - Street 2:
Practice Address - City:TARRANT
Practice Address - State:AL
Practice Address - Zip Code:35217-2402
Practice Address - Country:US
Practice Address - Phone:205-841-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist