Provider Demographics
NPI:1568813848
Name:BURDEN, DANIEL JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:BURDEN
Suffix:JR
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 1:5250 BOGGY RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-5853
Mailing Address - Country:US
Mailing Address - Phone:843-365-0301
Mailing Address - Fax:843-365-0318
Practice Address - Street 1:5250 BOGGY RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5853
Practice Address - Country:US
Practice Address - Phone:843-365-0301
Practice Address - Fax:843-365-0318
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist