Provider Demographics
NPI:1558584961
Name:BURLESON, MICHAEL ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:BURLESON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 GOLDEN BELL PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1402
Mailing Address - Country:US
Mailing Address - Phone:859-246-2820
Mailing Address - Fax:859-246-2823
Practice Address - Street 1:2624 RESEARCH PARK DR
Practice Address - Street 2:SPINDLETOP ADMINISTRATION BUILDING SUITE 302
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8504
Practice Address - Country:US
Practice Address - Phone:859-246-2820
Practice Address - Fax:859-246-2823
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist