Provider Demographics
NPI:1568875953
Name:BURDEN, KRISTINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:BURDEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 ELBERT ST
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-2641
Mailing Address - Country:US
Mailing Address - Phone:706-283-8735
Mailing Address - Fax:706-283-8003
Practice Address - Street 1:955 ELBERT ST
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-2641
Practice Address - Country:US
Practice Address - Phone:706-283-8735
Practice Address - Fax:706-283-8003
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist