Provider Demographics
NPI:1184224123
Name:BURPEE, SKYLAR HENDRICKS
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:HENDRICKS
Last Name:BURPEE
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 1:236 ANNESWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2610
Mailing Address - Country:US
Mailing Address - Phone:706-832-0109
Mailing Address - Fax:
Practice Address - Street 1:260 BOBBY JONES EXPY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2433
Practice Address - Country:US
Practice Address - Phone:706-860-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist