Provider Demographics
NPI:1225264252
Name:BURGESS, RAYMOND (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:BURGESS
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 1:124 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-2015
Mailing Address - Country:US
Mailing Address - Phone:716-635-5276
Mailing Address - Fax:716-635-5991
Practice Address - Street 1:124 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-2015
Practice Address - Country:US
Practice Address - Phone:716-635-5276
Practice Address - Fax:716-635-5991
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist