Provider Demographics
NPI:1164610515
Name:WANZER-BURGESS, PATRICIA ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:WANZER-BURGESS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:WANZER-BURGESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2332 WHITE OWL WAY
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1064
Mailing Address - Country:US
Mailing Address - Phone:301-736-8998
Mailing Address - Fax:
Practice Address - Street 1:79TH MED GROUP, MGMC 1050 WEST PERIMETER RD
Practice Address - Street 2:ANDREWS AIR FORCE BASE
Practice Address - City:ANDREWS AIR FORCE BASE
Practice Address - State:MD
Practice Address - Zip Code:20762-6600
Practice Address - Country:US
Practice Address - Phone:240-857-4566
Practice Address - Fax:240-857-4544
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist