Provider Demographics
NPI:1235263005
Name:BURGESS, HENRY III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:BURGESS
Suffix:III
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 1:100 SHOTWELL CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9769
Mailing Address - Country:US
Mailing Address - Phone:919-767-9738
Mailing Address - Fax:
Practice Address - Street 1:100 SHOTWELL CT
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9769
Practice Address - Country:US
Practice Address - Phone:919-767-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist