Provider Demographics
NPI:1598063000
Name:BURGESS, JEFFREY MATTHEW (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:BURGESS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MERIDEN RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1937
Mailing Address - Country:US
Mailing Address - Phone:203-573-0378
Mailing Address - Fax:
Practice Address - Street 1:141 MERIDEN RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1937
Practice Address - Country:US
Practice Address - Phone:203-573-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist