Provider Demographics
NPI:1518391507
Name:WINSAUER-BURKETT, CONSTANZE (RPH)
Entity Type:Individual
Prefix:
First Name:CONSTANZE
Middle Name:
Last Name:WINSAUER-BURKETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CONNY
Other - Middle Name:
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3201 FANNIN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 FANNIN LN
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3329
Practice Address - Country:US
Practice Address - Phone:817-602-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist