Provider Demographics
NPI:1407494644
Name:BURCH, MARIA (REGISTERED PHARMACIS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37220 MORAVIAN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3602
Mailing Address - Country:US
Mailing Address - Phone:586-212-4112
Mailing Address - Fax:
Practice Address - Street 1:28250 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5604
Practice Address - Country:US
Practice Address - Phone:586-558-2089
Practice Address - Fax:586-558-3291
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020275881835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist