Provider Demographics
NPI:1235414038
Name:BURNETT, VERNANCE PATRICE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VERNANCE
Middle Name:PATRICE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:VERNANCE
Other - Middle Name:PATRICE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:860 KINGSWAY DR W
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3022
Mailing Address - Country:US
Mailing Address - Phone:504-391-0937
Mailing Address - Fax:
Practice Address - Street 1:860 KINGSWAY DR W
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-3022
Practice Address - Country:US
Practice Address - Phone:504-391-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist