Provider Demographics
NPI:1447411756
Name:BURNETT, AMY
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
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 7011
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-7011
Mailing Address - Country:US
Mailing Address - Phone:708-786-7820
Mailing Address - Fax:708-786-7980
Practice Address - Street 1:5TH AVE & ROOSEVELT RD
Practice Address - Street 2:BUILDING 37 NW
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-786-7820
Practice Address - Fax:708-786-7980
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.032603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist