Provider Demographics
NPI:1174846901
Name:BURR, THEODORE A (RPH)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:A
Last Name:BURR
Suffix:
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 1:5626 STATE HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2050
Mailing Address - Country:US
Mailing Address - Phone:607-432-8636
Mailing Address - Fax:
Practice Address - Street 1:5626 STATE HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2050
Practice Address - Country:US
Practice Address - Phone:607-432-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist