Provider Demographics
NPI:1275821472
Name:BURTON, GARY DEAN JR (PHARMD, BCACP)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DEAN
Last Name:BURTON
Suffix:JR
Gender:M
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 S 38TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3953
Mailing Address - Country:US
Mailing Address - Phone:509-965-1035
Mailing Address - Fax:509-225-2700
Practice Address - Street 1:402 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3115
Practice Address - Country:US
Practice Address - Phone:509-249-5717
Practice Address - Fax:509-225-2715
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000516031835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist