Provider Demographics
NPI:1275959538
Name:BURNETT, JODIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0425
Mailing Address - Country:US
Mailing Address - Phone:573-820-0043
Mailing Address - Fax:
Practice Address - Street 1:333 S WESTWOOD BLVD STE OFC
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5500
Practice Address - Country:US
Practice Address - Phone:573-686-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001029145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist