Provider Demographics
NPI:1225350119
Name:BURCH, LAUREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BROADWAY FRNT
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1109
Mailing Address - Country:US
Mailing Address - Phone:212-227-6168
Mailing Address - Fax:
Practice Address - Street 1:305 BROADWAY FRNT
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1109
Practice Address - Country:US
Practice Address - Phone:212-227-6168
Practice Address - Fax:212-571-4679
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056936183500000X
SC12445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist